Medicare terms can sometimes seem like an unknown language, but understanding some of the most common Medicare terms can help make it easy for you to navigate through your Medicare options and make an informed decision. We have defined the top 5 Medicare terms you should know as you prepare to choose a Medicare plan that fits your needs.

Benefit Period

This is the set amount of time during which Medicare will pay for Skilled Nursing Facility (SNF) and hospital services. The benefit periods start upon your admission to a hospital or skilled nursing facility. It ends once you have been discharged and didn’t receive any inpatient hospital care for at least 60 days.

In the situation where you are readmitted to a hospital or SNF within the 60-day period, you’ll be in the same benefit period. A new benefit period will start if you are admitted after those 60 days have passed, and you will be subject to the Medicare Part A copays and deductibles.

Cost-Sharing

This refers to the portion of medical services received that you are responsible for paying. Cost-sharing includes a combination of deductibles, copayments, or coinsurance. Medicare Supplement Plans K and L are good examples of cost-sharing plans. Plan K typically covers 50% of out-of-pocket costs, whereas Plan L covers 75%.

Donut Hole

This is also known as the Coverage Gap. This is one drug coverage stage a beneficiary may experience while they are a member of the Medicare Part D plan. This is the period during which there is a gap in the prescription drug coverage provided by Medicare Part D. And you’ll remain in this hole until your out-of-pocket spending meets the predetermined limits.

Formulary

The formulary is referred to as the list of medications that a Prescription Drug Plan covers. The formulary includes both generic and brand name drugs and contains at least two of the most commonly prescribed medications within each drug class.

Initial Enrollment Period

The Initial Enrollment Period (IEP) is the 7-month period you have to enroll in Medicare when you turn 65. The 7-month period starts three months before the month you turn 65 and lasts until three months after you turn 65.  

As you near retirement, you may wish to consult a Medicare professional to become familiar with the Medicare program. This is where we can help. If you have any questions about Medicare, contact iHealthcare Direct today, and we can help you find a plan that suits your needs.

When it comes to receiving medical care, the billing aftermath can be devastating. Finding ways to pay for healthcare can be financially overwhelming, so it’s important that you know there are different options available to help you pay for medical bills if they should arise. Being aware of these options means that you’ll have the freedom to choose between them and decide which one is the right choice for you. One of these options are short-term health plans.

Short-term health plans

This type of policy is meant for people who are between forms of insurance. If you lost your job or are waiting to enroll in another policy, it’s still important that you have health insurance. Short-term health plans are an affordable way to make sure that you still have access to medical care without a typical form of insurance.

This type of insurance is typically much cheaper than many major medical policies. Taking advantage of this lowered cost is a great way to make sure that you’re paying reduced bills until you can enroll in another health insurance option.

It’s important to keep in mind that this type of policy exists in a wide range. Coverage options and pricing can all vary depending on the specific policy and what it offers. If you’re considering purchasing this type of health insurance, it’s important that you do some research and are aware of all the different choices available. Taking a look at the policies on the market will give you an idea of what will be the best choice for you and your medical situation. Fortunately, iHealthcare can do this research and make plan comparisons for you.

While coverage can definitely vary, short-term health plans will typically provide less coverage than other insurance options. But, since they’re not intended to be a permanent solution, they will typically include coverage for some emergency situations. This type of insurance is a great way to save some money and be prepared, but it’s not intended to be a forever policy.

Should you consider this type of policy?

If you’re not currently enrolled in a health insurance policy, you should consider if a short-term health plan could be the right choice for you. They’re an excellent option if you’re looking to get some coverage without paying high prices. Enrolling in a short-term health plan is a decision that could save you some money until you can enroll in a more permanent health insurance option.

If you don’t have health insurance, it can be overwhelming to think about the financial ramifications of a medical emergency. Short-term health plans work to reduce some of that worry by providing temporary coverage.

If you’re interested in learning more, you can make an appointment with me to discuss if a short-term health plan is the right choice for you. 

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.