As many of you know, the healthcare system in the United States does not provide universal coverage. And that means for most average families, medical expenses can add up pretty quickly -- this is especially so as you get older.

Designed to help older Americans or those with certain disabilities or conditions access affordable medical services, Medicare is a program that seeks to ease their burden by offering coverage on most, if not all of their healthcare costs. Yet there's a catch: It comes with deductibles. In this blog post, we will walk you through how Medicare deductibles affect how much you have to pay for medical services.

What Is Original Medicare?

Before we get to deductibles, let us run you through the basics of Medicare. The Medicare program is divided into four Parts. But Parts A and B are the two most essential components. They are also known as Original Medicare.

Medicare Part A (or hospital insurance) covers inpatient hospital stays, hospice care, skilled nursing facility care, and some home health care services. Most people do not pay a premium for Part A, as they have already paid into the system with payroll taxes from their working years.

Medicare Part B (or medical insurance) covers medically necessary services, such as doctor visits, outpatient care, preventative services, and medical equipment. Part B is optional, but requires a monthly premium payment.

Both Part A and Part B cover a wide range of medical services. But they do not cover everything. For example, they do not cover prescription drugs, dental care, vision care, or long-term care. For those types of services, individuals can purchase additional coverage with private insurance plans known as Medicare Advantage or Medicare Supplement plans.

How Medicare Deductibles Impacts Your Bill

So what is a Medicare deductible? Simply put, it's the amount you have to pay out-of-pocket for you healthcare expenses before Medicare starts covering it. For example, let's say your Medicare Part A deductible is $1,000. If you get admitted to the hospital, you would have to pay the first $1,000 of your hospital bills before Medicare kicks in and pays for the rest.

Think of it as an investment in your health. By paying your deductible, you're getting access to the full benefits of Medicare and ensuring that you have access to the care you need.

But note that deductibles can change each year. So if you have Medicare, you'll want to make sure you're staying current with your plan so you know exactly how much you'll be paying.

What Is the Medicare Deductible for 2023?

The Medicare Part B deductible is $226 per year for 2023. That means that once you've paid $226 for any expenses covered by Medicare Part B, you won't have to pay that deductible again for the rest of the year. Some services, like preventive screenings, may be covered without any out-of-pocket costs.

For Part A, the deductible for 2023 is $1,600 per benefit period. A benefit period starts when you are admitted to a hospital or skilled nursing facility and ends after 60 days of not receiving any inpatient care. If you are admitted to a hospital more than once in the same benefit period, you won't have to pay the deductible again.

What is a Medicare Advantage Plan?

A Medicare Advantage Plan (or Medicare Part C) is a type of health insurance plan offered by private insurance companies. These plans are an alternative to Original Medicare (Part A and B). They typically provide additional benefits and services. But it varies from plan to plan.

Now, they're required to offer the same benefits that Original Medicare does. But they may also offer things such as prescription drug coverage, dental and vision care, and wellness programs. Some plans may also include coverage for hearing aids, gym memberships, and other health-related services.

Medicare Advantage Plans typically have a network of doctors and healthcare providers that participants must use in order to receive coverage for medical services. Some plans may also require prior authorization for certain preventive services, or medications.

There are several different types of Advantage Plans out there, including Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Private Fee-for-Service (PFFS) plans. Each type of plan has different rules and regulations regarding coverage and provider networks. It's important to review the plan details carefully before enrolling.

In order to be eligible for a Medicare Part C Plan, you must be enrolled in both Medicare Part A and Part B and live in the plan's service area. Some plans may also have other requirements, such as certain chronic health conditions.

Overall, Medicare Advantage Plans can be a good option for those looking for additional benefits and services beyond what is covered by Original Medicare.

What Is The Medicare Part C Deductible?

Medicare Advantage Plans are offered by private insurance companies. So the deductibles would vary by plan and may not apply to all services.

Maybe you're thinking about enrolling in a Medicare Advantage Plan. Make sure to review its details to understand what deductibles, co-payments, and coinsurance requirements may apply. They may be different to what you are currently used to. Additionally, once you're enrolled, make sure to regularly check your plan's costs and benefits. That way you can make sure the plan continues to meet your healthcare needs and fits your budget.

How Do I Find The Best Medicare Plan For Me?

Trying to find the best Medicare plan may seem difficult. There is a lot to navigate. But there are a few steps you can follow to help you make the right decision.

If you are looking for an experienced Medicare agent that has your best interest in mind, EASY Insurance Plans will be happy to take the time and discuss your Medicare options.

By carefully evaluating your options, you can find the best Medicare plan for your needs and budget, and make your healthcare journey easy and hassle-free.

Medicare is a federal government program that aims to provide health insurance to people over the age of 65 and also those with certain disabilities or conditions. Over the years, it has helped many Americans who are otherwise uninsured to access basic and essential health care services at affordable cost.

Medicare coverage is divided into four parts: Medicare Parts A, B, C, and D. Part A & B, which covers essential medical needs such as outpatient and inpatient services as well as emergencies care, are together commonly known as the Original Medicare and sign-ups are mandatory for people over the age of 65. While signing up for Part A is free for most people, Part B normally incurs a premium that varies depending on an individual’s income level. The services also incur out of pocket costs.

On the other hand, Medicare Advantage plans, or Medicare Part C, refer to private medical insurance plans that are regarded as alternative to Medicare Part A & B. They are offered by private insurers which have been approved by Medicare and which provide the same benefits as well as additional coverage not available under Original Medicare. Some of the upsides of getting Medicare Advantage include lower out-of-pocket expenses and reduced premiums.

Medicare beneficiaries have to choose whether to go with Original Medicare or a Medicare Advantage plan when they enroll. In this blog post, we will walk you through how this part of Medicare works, and how it can offer you additional protection that are not covered by the other parts of the program. If you have questions at any time while going through this post, contact EASY Insurance to speak with an agent.

What Are The Four Part of Medicare? 

To make it easier for both beneficiaries and their families to understand, the four main parts of Medicare (A,B, C, and D) each focuses on providing coverage in one or several specific areas, ranging from emergency care to preventive services to hospital care to prescription drugs. And here they are:

• Medicare Part A: Hospital Insurance -- covers all inpatient hospital stays, care in skilled nursing facilities, hospice care, and some home health care
• Medicare Part B: Medical Insurance -- covers some doctors' services, outpatient and preventive care, and medical supplies
• Medicare Part C: Medicare Advantage Plan -- the private health insurance alternative to the original Medicare
• Medicare Part D: Prescription drug coverage -- covers the cost of prescription drugs, recommended shots and vaccines.

The Basics About Medicare Advantage

Based on rules set by the Government, Medicare Advantage plans need to include benefits that are equivalent to Original Medicare (hospice care maybe an exception). While these plans need to meet certain basic requirements, they may be different in premium levels, copayments, deductibles and other medical service expenses.

Some plans may even include prescription drug coverage and other additional benefits, such as cover the cost for vision, hearing and dental services. Here's a list of some of the items that maybe included:

• Routine dental care and dentures
• Emergency response devices
• Fitness benefits
• Hearing aids
• Prescription drug (Part D)
• Out-of-US emergency care
• Over-the-counter drugs
• Eye exams

The rules for Medicare Advantage plans on how you get services may be different than that for Original Medicare. For examples, for some you may need a referral to book an appointment with some specialists, while some plans may limit the choice of doctors and healthcare providers you can see within a specified network, though these restriction normally won't apply for emergency or urgent care.

What Affect the Costs for Medicare Advantage?

The cost of Original Medicare is set by the federal government who offer these plans. And the only factor that would affect the cost to a person enrolling is what income bracket he or she falls into

Unlikely Original Medicare, Medicare Advantage plans are offered by private insurance companies, meaning that there are plans that carry different features that you can choose from. In general, for both Original Medicare and Medicare Advantage plans, there are four components:

• Premiums: It is the amount the user pay on a monthly basis to enroll in the program. .
• Deductibles: It is a set amount users pay out of their pocket before the providers begin to pay for a service
• Copays: It is a set amount user have to pay at the time they receive the service, such as part of the fee for a doctor's appointment
• Coinsurance: This is a percentage of medical costs an individual is required to pay.

Average Medicare Advantage Plan Premium

In 2022, the average monthly premiums charged by private health insurance companies is $19, though cost vary based on the plan and the provider. Bear in mind that while Medicare Advantage includes coverage for Original Medicare, sometimes the plans charge a supplemental premium for the additional coverage

As the premiums vary from one plan to another, the same principle goes for deductibles, copayments, and coinsurance. But bear in mind that the amount on these may not be the same as the cost-sharing requirement of Original Medicare. Also, for Medicare Advantage plans there is also a cap on your annual out-of-pocket expenses, or your share of covered medical expenses.

Why Should You Get Medicare Advantage?

So if Medicare Advantage generally cost more, why should you get it? Well, there are plenty of reasons. For starter, Medicare Advantage plans usually come with coverage for prescription drug plans and other medical services not included in Original Medicare, such as vision and dental.

Also, because there are many types of Medicare Advantage plans from different providers, the premiums actually varies, with some costing as low as $0. And speaking of cost, many Medicare advantage plans may even come with lower copayments and coninsurance than Original Medicare, as well as limiting out-of-pocket expenses. The latter means you will pay nothing more for the year after you have met the stated maximum. This is very different from Original Medicare, which doesn't set an out-of-pocket limit.

That is why, if you have a condition that may require regular and expensive treatments, the out-of-pocket maximum of a Medicare Advantage plan will help limit your liability. On the other hand, since Original Medicare doesn't offer this protection, you may want to consider purchasing a Medigap policy to help cover the expense, or risk facing significantly higher costs.

Why Shouldn't You Get Medicare Advantage?

At the same time, there are some negative factors which you need to take into consideration when choosing whether to join a Medicare Advantage plan. First, some of these plans may restrict your choice of physician or health care providers to a network designated by them. And that if you need out of network services, you will have to cover your own cost. This is very different from Original Medicare, which covers any service providers who accept Medicare.

Also, not all Medicare Advantage plans are catered to users for the entire nation. Their network of providers may only be available to people who live within a specific region. Plans like these may not be a good fit for people who don't live in a single location all year round. And last but not least, some plans require referrals or authorization from your primary care physicians for certain services or operation, or if you want to see a specialist. Comparatively, it is far less common for Original Medicare to require these.

Enrolling in a Medicare Advantage Plan

If you have decided to enroll in a Medicare Advantage plan for the first time or to make changes to an existing one, you will have to wait for an enrollment period. The first window is called the initial enrollment period, which varies depending on your birthdate and the timing of your enrollment in Original Medicare. This initial enrollment period is a 7-month windows that starts from 3 months prior to your birth month to 3 months after.

Next there is the open enrollment period, which takes place on January 1 to March 31 each year. If you are enrolled in a Medicare Advantage plan already, you can use this period to switch to another plan. You can also withdraw from your Medicare Advantage plan and go back to Original Medicare.

For both the initial and open enrollment periods, the coverage begins on the first day of the month following the month you enroll.

If you have missed the open enrollment period, the next window is the annual enrollment period that runs from October 15 to December 7 each year. For these enrollments, coverage begins on the first day of the following year.

During this period, you can do the following: switching from Medicare Advantage to Original Medicare; switching from Original Medicare to Medicare Advantage; and switching between Medicare Advantage plans.

In certain circumstances, you may be eligible for a Special Enrollment Period outside of the open enrollment period. Qualifying events may include losing your job, getting married or divorced, having a child, or moving to a new state.

Finding a Medicare Advantage Plan

If you are confused about the terminologies and terms in the different plans offered by insurance providers, we are here for you

EASY Insurance Plans is dedicated to helping you find the right Medicare Advantage plan Our experts are available to provide answers and will not rest until your health care needs have been met. Best of all? Our services come at no cost to you! Let us help make sure that you get the coverage that best fits your situation - contact us today!

Buying a Medicare Advantage Plan or a prescription drug plan to accompany your Original Medicare plan requires you to compare plans and healthcare providers to determine which one can best meet your needs. That is not easy to do. Medicare plans are complex. There’s no way to know what you can expect from the drug coverage or the healthcare providers until you have a plan, right?

That’s where Medicare star ratings come into play. Each year, the Centers for Medicare & Medicaid Services (CMS) public star ratings, which are a basic star rating for each of the available policies. They are meant to give you some insight into what you are buying and what you can expect.

The Medicare Part D Star Ratings and Medicare Advantage (Medicare Part C) ratings can help you to learn the quality of health and drug services. The system allows you to compare the quality of Medicare health and drug plans so you can make a better decision to fit your needs down the road.

Let’s explain how they work and what these ratings should mean to you.

You are in the market to purchase a Medicare Advantage plan. Or, you may be planning to purchase a Medicare Part D prescription drug plan if you have Original Medicare. Most people want a low cost for the health insurance they select, but there is no point in purchasing health insurance that does not meet your needs. Finding that balance between affordable and quality Medicare insurance is your priority.

Who Sells These Plans?

Medicare Part D and Medicare Advantage plans are not sold or offered through Medicare. Rather, they are from private insurance companies. However, CMS monitors these plans and the companies on behalf of consumers. They gather information and align it to a simple 5-star system. That allows you to compare the plans for:

• How well they perform
• Their quality of coverage
• Member satisfaction

To be clear, you should not purchase a Medicare healthcare plan that does not meet your individual needs just because it has 5 stars. You still need to make sure the coverage aligns with your specific needs and goals.

What Are the Medicare Star Ratings?

Here is how the Medicare star ratings breakdown:

• 1 star rating – Poor service noted
• 2 star rating – Below average service noted
• 3 star rating – Average among all policies compared
• 4 star rating – Above average rating
• 5 Start – Excellent coverage, the best option for quality, performance, and service

That makes the entire process simple enough, but not everyone wants to pay the highest price for a 5 star plan if a 4 star plan is more affordable and offers the coverage you need. So how do you choose?

Learn How Medicare Star Ratings Work

When you need to purchase a prescription drug plan or a Medicare Advantage plan, you can compare several healthcare provider options on the CMS website. There, you will see the Medicare star rating listed.

The CMS calculates this rating based on the measurements of customer satisfaction and plan quality of care that it receives. These star ratings will change every year – that is one of the reasons you will want to compare policies annually to determine which one fits your goals and not just stick to the same plan each year.

The CMS uses the most recently available data to produce these ratings. Most of the time, it releases the star ratings in October before the launch of open enrollment periods for most people. There are some situations in which the star rating may be listed before or after this, generally when the healthcare coverage is a new policy to the marketplace that year. They may not have any rating that initial year because no members have provided that information just yet.

Medicare Advantage Plan Star Ratings

Medicare Advantage, also known as Medicare Part C, has its own set of factors that CMS uses to determine the quality of the policies and how well they meet the needs of consumers. To determine this information, the CMS looks at the following data:

• Member Experience: In this area, they consider how well the members of the health insurance plan benefit from it, specifically related to how easy it is to see a specialist if they need care. They also note how hard it is for members to get an appointment for the care they need in a short period of time.
• Plan Performance: They also look at the complaint history of the health insurance plan. Here, they want to determine if the performance of the plan – the good and bad of it as reported by members – is getting better or if it is worsening over time. They also track if members are leaving the plan as a determining factor in how well the plan fits their needs.
• Customer Service: This is a big one for most consumers. The CMS takes a look at what people are saying about the plan. Specifically, how well do members get the help they need when they have a member request? What happens during the appeals process?
• Staying Healthy: The next factor that plays a role in star ratings for Medicare Advantage plans is the access members have to the services they need to stay healthy. Is it easy to get checkups and routine care? Are screening tests paid for and available to the member? They also want to verify the access to vaccinations, and other needs members have.
• Chronic Condition Care: For many seniors and those on disability, chronic condition management is a big factor in choosing a plan. The CMS looks at the information available, including the availability of testing and lab work for various conditions. They also look at the treatment options available. Would members recommend the plan for those who have the same conditions they do?

Most Medicare Advantage Plans will have a prescription drug coverage component. CMS rates the Medicare Advantage Plan based on all components of the coverage it provides.

Medicare Part D Drug Plan star ratings

For those who are just purchasing a Medicare Part D drug plan, you will need to have insight into how well that healthcare plan works to meet your needs. The star ratings from CMS are a bit different here than they are for Medicare Advantage plans. Here is how they break down.

• Member Experience: This is still a big factor in the overall rating. How do members who have the plan rate it? Good or bad?
• Plan Performance: CMS looks at what is happening with the plan over time. This includes any history of complaints members filed against the plan as well as how the ratings for the plan have improved or worsened over time. They also look at why and how often members are leaving the plan.
• Customer Service: In this area, the CMS considers how well members report receiving quality service from the plan. They take a look at factors like how member requests are handled and how many appeals occur (including how they are treated).
• Drug Safety and Pricing: The final component is a consideration for pricing. How accurate is the pricing of the plan? Do those who have specific medication needs prescribed by their doctors able to get that care and can be prescribed drugs appropriately?

Each of the Medicare Part D plans will have a summary rating, which is an overall weighted average based on all of the factors that Medicare Part D measures.

Medicare Star Ratings: How to Use Them to Choose a Medicare Advantage and Part D Plan

Now that you have some idea about a plan’s star rating, you next need to consider how this information can impact your decision when choosing health care providers. The more information you have about health coverage before you find it – including healthcare effectiveness data – the more prepared you can be in choosing a policy that really meets your needs. The star rating system is one tool to help you in the process of choosing a health plan.

How to use the rating system and plan ratings for your needs

When you are within your open enrollment period, or you are making an enrollment request, you will want to gather information on the star rating from the one to five stars the plan has.

Look at all of the health plans to determine what their overall star rating is. Most of the time, you will want to use the summary rating to make a decision. Most often, on a scale of one to five stars, you’ll want to choose those policies with five stars. These are considered the best health plans.

Need more information? That’s great because the more insight you have into the performance measures and the health plan itself, the better.

Take into consideration what ratings range people typically sign up for. For the 2023 enrollment period, about 72% of all beneficiaries enrolled in a health plan with an overall star rating of at least a 4 when they enrolled in Medicare Advantage Plans.

The overall star rating for stand-alone Medicare Part D plans was 9% - meaning that about 9% of those who signed up chose a plan with at least a 4 star rating.

Don’t stop there when considering a plan’s performance. Instead, look at how well the plan works to meet the individual needs of those who have the same type of medical needs as you do, especially for chronic conditions.

To do this, you can look at the data for the measurement period about the plan’s performance based on other people who have the same health needs as you do. If you have diabetes, for example, you can look at how other people with diabetes say the plan met or did not meet their health needs. You can choose which type of chronic health conditions to look at based on the plan ratings.

You can do this using the Medicare Plan-Finding Tool. There, go under the “plan details” table, where you can select the chronic conditions you are facing.

When Can You Enroll in a 5 Stars Plan?

Medicare star ratings provide you with a tool to comparison shop, but when can you choose one of the prescription drug coverage plans?

You will need to sign up for a plan that meets your needs when you are eligible for open enrollment. You may be able to sign up for this information whenever you meet the requirements for eligible Medicare beneficiaries.

• Initial Enrolment Period: Most people will sign up for Medicare prescription drug coverage during their initial enrollment period. This period typically spans seven months. It starts three months before your 65th birthday and runs for three months after your birth month. It includes the month of your birthday as well. If you are new to Medicare prescription drug coverage, you likely will sign up at this period.
• Open Enrollment Period: After that first period, you can also sign up for a health plan during the Open Enrollment Period. This occurs each year from October 15th through December 7th. During this period, Medicare beneficiaries can choose the Medicare Plan right for them. The prescription drug plan they choose will then become active on January 1st of the following year.
• Special Enrollment Period: You may also be able to enroll during a special enrollment period. Medicare beneficiaries may qualify for a special enrollment period if they become diagnosed with a medical condition that meets the requirements for disability.

Another time when you may be able to switch occurs when you want to move from the policy you have now to a 5 star plan. If the star ratings for your existing plan are low, you may be able to switch to one with a 5 star rating. This is a one time special enrollment period – which means Medicare beneficiaries can only do this one time. This period runs from December 8th through November 30th. You can only switch from a low performing plan to a 5 star plan one time during that period.

What if you do not purchase MA plans during the right time of the year? If you sign up outside the enrollment period allowable, you may have to pay a late enrollment penalty. That penalty will carry on over the lifetime of your coverage and may impact the plan’s pricing.

When Will Medicare Star Ratings Be Updated?

Star ratings do not update in real time. Rather, the star ratings will be updated in the fall, prior to the next year. This data comes from member satisfaction surveys completed in the year before. Consumer assessment like this is very valuable, but the overall rating only changes once time a year.

For this reason, when you need to purchase Medicare Part D drug plans or a Medicare Advantage Plan, you will want to look at star ratings that are most up to date. Prescription drug plans of all types should be compared, but start ratings are not all that you need to consider.

How to Choose the Best Medicare Part D Drug Plans or Medicare Advantage Plan for You

Star ratings are one component of the factors that you need to consider. When looking at Medicare Part D plans and Medicare Advantage star ratings, you will need to consider a range of data.

What medical conditions do you have?

When choosing any plan, you want to know how people who have the same medical needs as you have received care from the drug plans. List those conditions you have that are important to you, such as heart disease or diabetes.

What is the plan's pricing information?

Always choose a health plan that fits your needs. Yet, it is not logical to think that the plan's pricing information does not matter. While you may not want to choose a plan with fewer than three stars just for a lower price, you do want to consider the overall benefits the plan offers.

Drug pricing information is available during open enrollment. Before selecting one, you should always know the cost of the Medicare Part D prescription drug plan or the Advantage plan.

What additional cost is involved?

Though it can occur for many reasons, including changing costs over time, you should know what to expect for all costs. That includes things like types of treatment that may not be covered or medications the policy does not cover.

Is your doctor in the network?

As you consider star ratings, be sure that you also consider how well the policy fits into your life right now. You certainly have the right to make a switch to a new doctor if you want to do so, but you may not want to do that. For that reason, make sure the Advantage plan or prescription drug plans cover the medical providers, hospitals, and other care that you need. You want to be sure that the plan helps you in staying healthy and meet your healthcare needs over time.

Are your preferred cost-sharing pharmacies present in your area?

Also, look at the plan's ability to meet your current prescription medication requirements. Does the pharmacy you want to use have coverage under the plan? Choosing prescription drug plans with high star ratings can be a good thing, but only if the coverage you need for your medications is included.

What member complaints are there?

Most people know the importance of choosing a policy that fits their needs. The plan's rating can matter, too. You also need to consider member complaints or any information you find about the policy. That could be very important in situations where member complaints have driven down the plans star ratings. Those with fewer than three stars, for example, may have significant consumer complaints. You should know about that before you choose them. Also, consider any improvement measures the organization has taken to improve the plan's pricing information, drug safety, and other factors alongside the plan's quality.

Answering Your Star Ratings Questions

Do you have questions about any Medicare plans? Be sure to reach out. Don’t assume you know what is covered or what is not – that could cost you significantly over time. Here are some common questions.

My plan has a low star rating. I want to switch because I’m frustrated with it. Do I have to wait until open enrollment?

No, you do not. Each year, you are given a special enrollment period. This is outside of what the normal enrollment periods are. This tends to have for special reasons. If you are awarded that period, you are then able to enroll in another plan, generally a five-star plan, that better meets your needs.

When will the star ratings for Medicare plans and prescription drug plans update?

There is no specific date that this is done. It happens one time a year. Most of the time, it occurs in the fall, usually before the open enrollment period begins. That way, you can compare policies and be able to learn as much as possible about the health plan before you make the decision to switch.

Will it cost me more if I switch from one plan to the next?

Not necessarily. When it is time for you to pick a new plan, wait until the Centers for Medicare & Medical Services updates the star rating and drug pricing information. Then, start comparing. You are able to see how much a new plan will cost you right there. You may find that it costs less to switch to a new plan than to stay with the old one. Other times, you may want to switch because of the plan’s rating or because you want a different type of coverage. That may mean paying more.

There is no penalty to you when it comes to switching providers every year, especially if you do so during the open enrollment period. You can also switch from a stand alone Part D prescription drug policy to Advantage plans during this time, too. There’s no higher fee for doing so.

Do you qualify for Medicare? If so, you may be able to obtain healthcare coverage for many of your needs.

What Is Medicare?

Medicare is a type of national health care program in the United States. It is available to certain people who reach the age of 65 as well as those who qualify due to a disability. It also provides coverage to people who have amyotrophic lateral sclerosis and end stage renal disease. It provides health insurance to those who qualify.

Medicare isn’t a new program. It’s been present in the U.S. since 1966, but it has changed and continues to change. That’s why it’s so important to know what your rights are when considering this investment. The Centers for Medicare and Medicaid Services oversees the program.

If you qualify for it, it may provide you with the medical insurance you need. Medicare coverage isn’t a simple policy, though. Here is what you need to know.

When Can You Sign Up for Medicare?

Typically, a person can sign up for Medicare when they reach retirement age, which is turning 65. However, if you are still working at that point and have health insurance from your employer, it may be better to maintain that policy longer and enroll in Medicare later.

When you begin to approach retirement age, you’ll learn more about open enrollment. That is the period of time that starts three months before you turn 65. It will end 7 months after your birthday. That means you need to be able to act within that timeframe.

If you become disabled or qualify for Medicare due to other health conditions, you can apply for Medicare directly at any time. You’ll need to meet the government’s requirements for qualifying based on your health condition.

Understanding Medicare’s Plans

The federal health insurance program gets confusing when you start looking at the various “plans” available. Let’s break down the details.

Original Medicare                

The term “original Medicare” refers to the basic form. Under this policy, you will receive coverage for parts A and B.

Part A Medicare coverage is hospital insurance. That means this part of the policy covers some of the costs you pay when you are admitted to the hospital for medical care. Part A may cover the following:

• Inpatient care at the hospital
• Hospice care at the end of life
• Skilled nursing facility care
• Home health care, with limitations

Part B Medicare coverage is designed to provide you with medical insurance. It helps you cover costs related to going to the doctor and receiving the preventative screenings you need. Part B includes:

• Outpatient care at your doctor’s office
• Home health care, in some cases
• Doctor care at a facility when you do not stay overnight
• Durable medical equipment, such as lifting equipment, wheelchairs, and hospital beds, you may need at home
• Preventative health care and screenings

When you sign up for this type of policy, it is very important to see the limitations. Parts A and B do not provide coverage for prescription drugs. They also do not cover dental and vision care. It does not cover any coinsurance, deductibles, or copayments that you have to pay for service either.

Remember, Part A covers the costs of your stay in the hospital, while Part B medical insurance covers preventative care, like when you see your doctor for a checkup. That’s where additional policy options are available that are not included in Original Medicare.

Many people who have Original Medicare will purchase a Medigap plan or go with Medicare Advantage Plan options. These are different types of services that could help to extend our coverage beyond what Original Medicare does.

Part D Prescription Drug Coverage

Prescription drugs are a big part of the out of pocket costs most people have over time. To get coverage for your medications, you will need to purchase Prescription Drug Coverage, also known as Part D. Private insurance companies provide Part D coverage. It does not come from the federal government.

Part D prescription drug coverage is regulated by the federal government. That means many plans are similar to each other. However, it’s still wise to compare policies to find the best one for your needs.

What Is Medigap Coverage?

When choosing health coverage, it is very important to choose a policy that gives you ample protection against the cost of medical care. Medicare coverage does not do that. It does not provide for all of the costs you are likely to need.

This is where choosing additional coverage that goes above and beyond what the federal government offers is very important. While you can purchase private insurance, most private insurance policies are very expensive, and that makes them difficult to access as you get older. However, Medigap can offer some protection.

Medigap coverage is also known as Medicare Supplement Insurance. This is one option that you can select to help fill in some of the gaps left by Original Medicare. It can help to cover things like copayments, coinsurance, and deductibles. Here’s how it works.

• You sign up for Original Medicare and Medigap coverage. Medigap is a separate supplement insurance that is sold by private insurance companies.
• When you file a claim, Original Medical care will pay for some of those costs – usually 80% of most covered needs.
• Medigap then fills in the rest, paying the rest of your cases.

Medigap has limitations. For example, it does not provide you with prescription drug coverage. You still have to purchase prescription drug coverage separately. This is a big drawback for many people since medications can be a large part of the out of pocket costs you pay for your medical needs.

What Is a Medicare Advantage Plan?

An alternative for purchasing Medicare supplement insurance is to invest in a Medicare Advantage plan. Medicare Advantage Plans are sometimes called Part C Medicare or MA Plans. These policies come from private insurance companies that must follow specific rules and regulations set up by the federal government to protect policyholders.

Medicare Advantage plans often include drug coverage, Part D. That means that, instead of purchasing Original Medicare, Medicare Medigap Plans, and Part D, you can purchase Medicare Advantage plans that include all components of your coverage.

In these plans, you will receive health coverage for many of your needs. You will likely have to choose a medical provider that is within the plan’s network. There is then a limit to the amount of money you have to pay in out of pocket costs for your care.

What healthcare services do Medicare Advantage plans include?

In addition to providing Medicare Part A and B benefits, Medicare Advantage can go further than this. These plans often include the following:

• Emergency medical care
• Urgent medical care
• Preventative services like wellness checkups
• Home health services
• All medically necessary services that are provided under Original Medicare
• Hospice care
• Some plans include vision, dental, and cash cards to help you with additional costs
• Some plans cover things like fitness programs, like a gym membership or discounts.
• Some may cover transportation to doctor’s visits.
• Some plans cover over-the-counter medications that Part D insurance does not cover that help to support health and wellness

When choosing these plans, you will need to compare their details carefully. There are several options, and not all are the same. This lets you choose coverage that is a good fit for your specific needs, though, and that can be well worth it.

There are some exclusions to all of these health coverage options. For example, your doctor visits are covered if they are in network, and some providers will cover some out-of-network doctor visits. However, this type of policy typically does not cover cosmetic surgery or non-health-based care. It is important that you know what the policy offers to ensure you receive ongoing coverage that meets your needs.

Common Questions About Original Medicare and Medicare Advantage

There’s a lot to think about and plan for when it comes to getting the medical health insurance you need. It’s best to take some time to really explore what your options are. To help you, consider these common questions.

What Does Original Medicare Mean?

If you have Original Medicare, that means you have Parts A and B, which are a part of your Social Security benefits. Part A hospital insurance will help pay for the costs of your medical care when you are admitted into the hospital for a qualified need. The services covered in the hospital include most testing, your care, procedures you have to have, and other needs for inpatient hospital care.

Part B medical insurance helps provide for your routine medical appointments. It may also help cover the costs you have for specific concerns like end stage renal disease when you have permanent kidney failure, Lou Gehrig’s disease, skilled nursing facility care, and outpatient medical care.

How Do I Get Drug Coverage?

If you meet the requirements of the general enrollment period right now, you can sign up for Original Medicare along with Part D drug coverage. This is a separate fee from a private insurance provider. Medicare Part D prescription coverage is an additional cost for your care but can cover most of the cost of your medications as a component of your Medicare benefits.

An alternative to this is to use Medical Advantage Plans. This will cover your Medicare Part B medical, Medicare Part A hospitalization, and Medicare Part D coverage. This means you will have hospital care, medical care for your health care costs, and drug coverage.

Do You Need Supplement Coverage if You Have an Advantage Plan?

No, If you decide to choose a Medicare Advantage Plan, you cannot have supplemental coverage through Medigap.

What Is the Cost of Medicare?

One of the difficult components of getting the medical care you need is understanding the costs Medicare charges.

The cost of Medicare will change each year. During the general enrollment period, you will be able to see the costs so you can choose what works best for you.

Here is a look at some of the costs you can expect for 2023:

Cost for Part A Medicare

Typically, this is $0 if you have paid into Medicare taxes while you were working. Most of the time that means you paid it for at least 10 years. If you do not qualify for premium-free Medicare, you may be able to purchase it at a cost.

There is a $1,600 deductible for Part A that is applied every time you are admitted to the hospital during the benefit period. You must pay this amount before Original Medicare will cover your health costs.

There is a copayment cost that is dependent on the length of your stay. There is no copayment for the first 60 days. From Day 61 to day 90, this is $400 each day. From Days 91 to 150, you pay $8000 in copayments using your 60 lifetime reserve days. After 150 days, you pay all costs.

Costs for Part B Medical Insurance

With Original Medicare, you will pay a monthly premium for your Part B medical insurance. For 2023, this was $164.90 each month but could be higher if you earn more than the limit. This amount will change each year. Even if you do not use any services covered by Part B, you still have to pay this fee to remain enrolled in coverage.

Also, you may pay a penalty if you do not sign up for Part B when you are first eligible for coverage. This is a late enrollment penalty that could be as much as 10% for each year you could have signed up but did not do so. If you learn you do not have creditable drug coverage because you did not sign up for coverage when you earned Medicare eligibility, you may have to pay this fee.

Costs for Part D Drug Coverage

When you purchase health insurance, the cost of prescription drugs is nearly always a big factor. However, since Part D is separate from Original Medicare, Parts A and B, you will pay additionally for this plan on top of the costs for Part A and B. However, these costs range widely between providers. The monthly premiums will be provided to you when you begin to compare your options, but know that the costs will vary significantly from one person to the next.

Medicare Part D coverage is one of the most important parts of Medicare for many people. Be sure that you consider the value of having this as a component of your Medicare plan.

Costs for Supplemental Coverage and Medicare Advantage

As you consider the options to enroll in Medicare, carefully consider the costs associated with supplemental coverage and Medicare Advantage plans. Both of these policies are premiums you will pay monthly to gain access to the Medicare Plan. There’s a difference though:

• Medigap supplemental coverage is an additional cost on top of Part A and B and drug coverage.
• Medicare Advantage is not an additional cost but rather a single cost you pay that will cover services.

How Does Social Security Disability Insurance Apply?

Some people become injured and cannot work as a result of that. Social Security Disability insurance may help you to cover your costs. That is, if you qualify for disability through Social Security, you may be then able to receive Medicare. In this situation, you do not have to wait until you reach the age of 65, nor do you have to wait until you have an open enrollment period. You will qualify based on your disability.

However, there is a 24-month qualifying period. That means that when you begin to receive Social Security Disability Insurance benefits, you will receive Medicare after 24 months passes. This waiting period means that you will not have health insurance through Medicare during that time.

If you need health insurance prior to this, you may be able to qualify for Medicaid services. Medicaid services are based on your income and are not the same as Medicare, but they can provide you with some of the coverage you need while you wait for disability benefits to become available to you to cover your healthcare needs.

How Do I Know When My Enrollment Period Begins?

If you are getting older, you may want to start planning for coverage. Your initial enrollment period begins three months prior to your 65th birthday. You typically do not have to do anything, but Medicare will alert you to your ability to qualify. You will likely receive a great deal of information at that time about Medicare Part A and B, as well as when you need to sign up for coverage within your enrollment period.

You will also get information about all of your options, including Medicare supplemental insurance and Medicare Advantage Plans.

How Can You Get The Coverage You Need?

From skilled nursing care to help with physical and occupational therapy after an in hospital stay, there are a lot of times when you may need medical care. Medicare is a government program that may help you cover services and costs, but understanding your options and the parts of Medicare is critical. That is why it is so important for you to seek out some help as you compare private insurers and health care providers.

If you paid Medicare taxes, you may have the ability to get benefits and let Medicare pay your medical bills. Let our team help you.