Medicare is a federal health insurance program designed to cover medical costs for citizens or legal residents that are 65 years old or older. Some people who are under 65 can also enroll in the program if they meet certain qualifications.
Medicare consists of various parts. Part A and Part B are known as Original Medicare, while Part C is known as Medicare Advantage. There is also Medicare Part D and Medicare Supplements.
Medicare Part A
Medicare Part A, which is part of what is known as Original Medicare, provides coverage for inpatient hospital services. Beneficiaries who are admitted to a hospital based on a doctor’s order will get coverage for certain hospital costs.
Under Part A, you’ll also get coverage for skilled nursing facility care, hospice care, and some home healthcare services. For beneficiaries who have paid the necessary Medicare taxes while employed, there will also be no premium for Part A.
Medicare Part B
Part B is the second part of Original Medicare. Under Part B, Medicare beneficiaries get coverage for outpatient healthcare services such as preventive screenings, doctor visits, durable medical equipment, and more. Many Medicare enrollees enroll in Part A and Part B to get more coverage for their healthcare expenses.
In some cases, Part B will also cover certain prescriptions, like immunosuppressants or anticancer drugs.
Medicare Advantage
Medicare Advantage is also called Medicare Part C and covers the same services as Parts A and B. It covers inpatient and outpatient procedures and services like doctor visits, preventive screenings, hospice care, medical equipment, and other medical expenses.
Most Medicare Advantage plans also include coverage for prescription drugs and extra benefits such as routine hearing, dental, vision, and more. However, to enroll in Medicare Advantage, you must be enrolled in Original Medicare. Also, you must continue to pay your Part B premiums, though some Part C plans may not even have a premium.
Medicare Part D
Medicare Part D provides coverage for at least two drugs in each class or category. These plans are also required to cover most, if not all drugs listed in these specific categories:
- Anticonvulsants
- Antipsychotics
- Anticancer
- Antidepressants
- Immunosuppressants
- HIV/AIDS drugs
Medicare Supplement Plans
Medicare Supplements, also known as Medigap, help to cover the out-of-pocket expenses that Original Medicare does not cover. While each Medigap plan provides different coverage, here is a general idea of what could be covered:
- Coinsurance
- Copayments
- Deductibles
- Excess charges
- Foreign travel emergency care
- Blood transfusions
What Does Medicare Not Cover?
While Medicare does cover quite a bit of services, there are some services that Medicare does not cover, such as acupuncture, cosmetic procedures and medications, and long-term care. This is why it is important to understand what each part covers before you enroll.
To learn more about what each part of Medicare covers and what your options are, reach out to us today by giving us a call at 713-900-1901.
One of the enrollment periods for Medicare applicants is the Open Enrollment Period. The Open Enrollment Period is an opportunity for people who are eligible for Medicare to sign up if they missed their Initial Enrollment Period. The Initial Enrollment Period starts three months before turning 65 and ends three months after your 65th birthday. This is when most people are first eligible to enroll in Medicare.
What is the Open Enrollment Period?
After the Initial Enrollment Period, the Open Enrollment Period (also known as the General Enrollment Period) is another chance to enroll in Original Medicare. This period starts on January 1 and ends on March 31 each year. If you enroll in Medicare during this period, your coverage will become active on July 1.
However, while this does offer a great opportunity for people to enroll in Medicare when they miss their initial enrollment, keep in mind that many people will pay late enrollment penalties when they enroll during this period. Unfortunately, the penalty for Medicare Part B is a permanent penalty and cannot be paid off. It will also be added to your Part B premium. For this specific reason, we always recommend that you enroll as soon as you become eligible so you can avoid these penalties and the gaps in coverage.
Late Enrollment
As we have mentioned before, enrolling during this period can result in late enrollment penalties. However, if you have creditable coverage and delay your Medicare enrollment, you can qualify for another enrollment period known as the Special Enrollment Period. This particular period will let you enroll in Medicare and not have you pay late enrollment penalties. But, again, you must qualify for it. If you do not, then the Open Enrollment Period is your only option.
With this said, we recommend that you do not wait a long time before you enroll in Medicare. That’s because the longer you wait, the more your late enrollment penalties will cost. For example, the penalty for Part B increases by 10% for each 12-month long period you did not have Part B coverage but could have enrolled.
If you need help with learning the different enrollment periods so you know when to enroll and can avoid late enrollment penalties, contact us today at 713-900-1901. We are ready and able to help you make informed decisions on your healthcare and will walk you through every step of the enrollment process.
ACA plans refer to health insurance plans that are sold on the health insurance marketplace. These marketplaces are managed by the state or federal government. By law, All ACA plans must cover certain essential benefits. These benefits must include:
- Emergency services
- Outpatient services
- Hospitalization
- Maternity care
- Mental health care
- Behavioral health services
- Prescription drug coverage
- Rehabilitative services
- Habilitative services
- Pediatric services
- Preventive and chronic disease management services
There are four different types of ACA plans: PPO, POS, HMO, and EPO.
PPO, HMO, POS, and EPOs
Preferred Provider Organization plans (PPO) are one of the most popular ACA plans. PPO plans allow you to visit any in-network provider without requiring a referral. Also, the plan provides coverage for in-network and out-of-network care, though out-of-network care costs more. If you want the freedom to choose any healthcare provider or you want some out-of-network care coverage, then PPO plans may be right for you.
HMO plans will require you to choose a primary care doctor, and you will need a referral for specialist visits. However, many HMO plans have lower out-of-pocket costs. This is because HMOs provide healthcare coverage that is limited to in-network providers.
Point of Service plans are basically a combination of HMO and PPO plans. Like an HMO, a POS will require you to choose a primary care doctor and get referrals when needed. But, like a PPO plan, you can also receive your care outside of the provider network, though this will cost more.
With Exclusive Provider Organization (ECO) plans, you can exclusively use the healthcare providers within the plan network but cannot get coverage for out-of-network care.
ACA Plan Categories
ACA plans are also grouped by metal tiers, or categories. The metal tiers are not used to determine the quality of care. They are used to determine how the costs will be split between you and your chosen plan.
The four metal tiers are bronze, silver, gold, and platinum. In the bronze plan, 60% of medical costs are paid by the insurer, while the consumer covers 40%. Bronze tier plans have the lowest monthly premiums, but the highest out-of-pocket costs.
Silver plans cover 70% of medical costs while the policyholder covers 30%. The monthly premium cost is considered moderate compared to higher tiers.
Gold plans have higher premiums but lower deductibles. They cover 80% of the medical costs, while you cover 20%.
Platinum tier plans cover 90% of the medical costs. They have the lowest deductibles but have the highest premiums. However, the plan will cover almost all the medical costs.
Contact Us Today!
At iHealthcare, our agents will guide you through the process of choosing an affordable health insurance plan suitable for your healthcare needs. For more information on how we can help, call us today at 713-900-1901.
