Understand Your Medicare Coverage Options
Medicare will usually pay a portion of the costs associated with covered medical expenses. Most people will also purchase a “Medicare Supplement Plan,” also known as a Medigap Policy, to help with the out of pocket expenses that fall under the deductible or coinsurance of original Medicare. Prescription drug coverage is referred to as “Part D” and is usually obtained separately. If you’re a California resident looking for a local Medicare health insurance company you can trust, you’ve come to the right place.
ORIGINAL MEDICARE
At age 65 most US citizens earn the right to enroll in Medicare. Eligibility is based on whether you have worked the minimum required amount and made the required contributions through payroll taxes over your lifetime. For people that don’t meet the requirement, they may still participate in Medicare but will have to pay more. In some cases it is also available to people under age 65 if they are totally disabled.
Medicare is a federal health insurance program that will pay for medical expenses such as hospitalization, surgery, and doctor visits.
Medicare has four parts:
Part A: Hospitalization and some skilled nursing
Part B: Expenses outside the hospital
Part C: – Medicare Advantage plans
Part D: – Prescription Drug plans
In most cases, once someone enrolls in Parts A and B of Medicare they will also purchase a Medicare Supplement or Medicare Advantage Plan to help cover costs not paid by Medicare. You should also enroll in a Part D plan.
MEDICARE SUPPLEMENT
What is a Medicare Supplement (Medigap Plans)?
Medicare Supplement Plans are meant to cover some of the health care expenses not covered by Original Medicare, such as deductibles, copays, and coinsurance. These plans are regulated by private insurance carriers. Because they are regulated, a Medicare Supplement with one insurance carrier must be identical in benefits as that same plan with another carrier. The only difference would be how much each carrier charges for the plan.
You must be enrolled in Medicare Parts A and B to purchase a Medicare Supplement.
As long as you apply during your Initial Eligibility Period, you are guaranteed coverage!
Normally, you have 6 months after turning 65 or obtaining Part B to apply for a Medicare Supplement Plan, where you can't be turned down. If you have a qualifying event such as a loss of coverage, this would open up a Special Enrollment Period, where you could still obtain a Medicare Supplement, even if older than 65. You can apply for coverage outside of Open Enrollment Periods, but you would have to answer health questions and your application would be subject to underwriting, where an individual could be denied coverage.
Medicare Supplement Plans do not come with Part D Prescription Drug Coverage. You would need to purchase a Part D Plan separately.
Medicare Supplement Plans are "not", the same as Medicare Advantage Plans
Medicare Advantage
Some people choose to enroll in Part C of Medicare, known as Medicare Advantage Plans, instead of being covered by original Medicare.
Medicare Advantage plans will usually cover everything that original Medicare covers. The difference is that the deductibles, copays, and coinsurance could differ from original Medicare benefits, so the amount you pay for medical expenses would be different depending on which plan you choose.
Medicare Advantage plans are usually extremely low cost and can be a good alternative to paying the premiums for both original Medicare and a Medicare supplement (also known as Medigap) plan. Some Medicare Advantage plans also include prescription drug coverage, which would eliminate the additional premium for a Part D plan as well.
Please keep in mind that Medicare Advantage plans are not currently offered in Shasta County.
Part D
Part D of Medicare provides coverage for prescription drugs. Part D plans are offered through private insurance carriers and the benefits can vary dramatically depending on the prescriptions you take. Plans are priced based on the level of benefits. Some plans have the maximum deductible allowed by government regulations and are relatively low cost. Conversely, other plans could have no deductible and cost considerably more. An important factor when comparing Part D plans is your prescription use. Each plan has its own specific prescription drug formulary and pharmacy network.
Because of these differences, it is very beneficial to have an experienced insurance agent who can help explain the plan benefits and make sure your specific prescriptions would be covered.
It’s important to enroll in a Part D plan at the same time you enroll in Medicare. If you don’t, a late enrollment fee will be added to future premiums unless you have qualified prescription drug coverage through another source, such as your employer.
MEDICARE RESOURCES
FREQUENTLY ASKED QUESTIONS
What are the different parts of Medicare?
Medicare is made up in four parts:
Part A: Pays for inpatient hospital services, skilled nursing, and hospice expenses.
Part B: Pays for many eligible medical expenses outside of the hospital.
Part C: These are Medicare Advantage Plans, health plans offered by Private Insurance Carriers as an alternative to using Original Medicare. Some plans also include coverage for prescriptions.
Part D: Prescription Drug Plans offered by Private Insurance Carriers to help pay for prescription drugs.
Can I ever change my Medicare Supplement Coverage?
You may change to an equal or lesser plan with any carrier during the month of your birthday, or you may change any time during the year with proof of insurability. You may also change to a Medicare Advantage Plan during the open enrollment period, if available in your region.
If you still have questions or would like to make an appointment, contact Shasta Health Insurance.
Do you have additional questions about Medicare? Please contact us at Shasta Health.