Insurance can be a very complex issue to navigate. I will try to assist by defining key terms in understanding the various parts of Medicare. There are 4 main parts to Medicare:
Part A – Hospital Coverage
Part B – Medical Coverage – Physician Office
Part C – Medicare Advantage Plans
Part D – Medicare Prescription Coverage
According to Medicare.gov, here are the terms you need to understand:
Medicare
Medicare is a federal health insurance program for people 65 and older and certain younger people with disabilities. It also covers people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).
Medicare isn’t part of the Health Insurance Marketplace.
Part B covers 2 types of services
You pay $185 per year in 2019 for your Part B deductible. After your deductible is met, you typically pay 20% of the Medicare-approved amount for these:
To get help paying your 20% consider purchasing a Medigap plan.
Medicare Part C plans are offered by private insurance companies. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan and aren’t paid for under Original Medicare. Most Medicare Advantage Plans may offer prescription drug coverage as well.
There are other less common types of Medicare Advantage Plans that may be available. To learn more about these types of plans visit Medicare.gov.
TIP: Medicare advantage plans are only required to pay what Medicare pays, which is 80% of allowable charges. In many plans, patients are required to pay the 20%. Make sure you understand your out-of-pocket cost when choosing one of these plans. You may NOT add a Medigap plan on to a Medicare Advantage plan.
TIP: If you are on a treatment plan taking chemotherapy or biologic therapy make sure you understand your out-of-pocket expense on these drugs. For example, some Part C plans will have approximately $6,000 that the patient needs to pay before the insurance kicks in to pay for these treatments. If you are not sure, call the plan and ask what your out-of-pocket expenses are for these treatments. That is very important. If you just ask if it is a covered drug, they will say yes. This is correct — but at what expense is the key information you need to understand. Remember: getting all the information will help you make an informed decision. Knowledge is Power.
TIP: You can join Medicare when reaching the age of 65. Switching between traditional Medicare and a Medicare Advantage Plan can only happen during Open Enrollment period. The Open Enrollment period for 2020 will be from October 15th and continue until December 7, 2019. Between January 1st and March 31 each year, if you are enrolled in a Medicare Advantage Plan, you can leave this plan and return to Traditional Medicare and purchase a Medigap plan. You can also purchase a Prescription or Medicare Part D plan. In 2019, it also allowed you to switch between Medicare Advantage Plans. Only one switch is allowed during this time period.
A Medicare Supplemental Insurance (Medigap) policy helps pay some of the health care costs that Original Medicare doesn’t cover, like:
Medigap policies are sold by private companies.
Some Medigap policies also cover services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, here’s what happens:
What you need to know about Medigap plans
Remember Medigap policies don’t cover everything
Medigap policies generally don’t cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.
According to Medicare.gov here is what you need to know regarding retiree coverage.
If you’re retired and have Medicare and group health plan (retiree) coverage from a former employer, generally:
How your retiree group health plan coverage works depends on the terms of your specific plan. Your employer or union, or your spouse’s employer or union, might not offer any health coverage after you retire. If you can get group health plan coverage after you retire:
Since Medicare pays first after you retire, your retiree coverage is likely to be similar to coverage under Medicare Supplement Insurance (Medigap). Retiree coverage isn’t the same thing as a Medigap policy but, like a Medigap policy, it usually offers benefits that fill in some of Medicare’s gaps in coverage—like coinsurance and deductibles. Sometimes retiree coverage includes extra benefits, like coverage for extra days in the hospital. For more information please go to www.medicare.gov.