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An Easy Overview of Medicare to Help You Decide

Medicare is a federally owned and administered health insurance program that covers health costs for the low-income seniors under certain programs or parts: Part A, Part B, Part C (Medicare Advantage), Part D, and Medicare Supplement (Medigap). This time of the year (fall season) is your chance to enroll in Medicare or consider Open Enrollment.

Who is eligible for Medicare?

Chances are that you might have been confused by the plethora of blogs available out there on these topics. However, rest assured, as this blog is going to introduce you to the terms without jamming up everything and also without over-simplifying them to help you chose a suitable plan for yourself.

Now that we know about Medicare, let’s see its eligibility.

Medicare benefits can only be enjoyed by seniors who have turned 65 years. However, there are special cases for younger people:
Those individuals are who have been receiving Social Security Disability Insurance (SSDI) for more than 24 months,

People younger than 65 who have been diagnosed with End-Stage Renal Disease (ESRD), or

Those who have been diagnosed with Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s disease).

Alright, after knowing about eligibility, we should delve further into knowing its parts which have been stated in the introduction: Part A, Part B, Part C, and Medigap.

Original Medicare

Starting with the Original Medicare, it includes two parts:

Part A (hospital insurance)

Medicare Part A covers most of the necessary care that could be availed at the hospital, skilled nursing facility, hospice, and home health services. The benefits can only be received by in-patients or the patients who are to get the care locally at the hospital.

For those people who have worked for at least 10 years and have paid Social Security Taxes in this period, this hospital insurance is free. While, people who have worked for less time and thus paid fewer taxes than the stipulated time, then they have to pay extra for the coverage in the form of monthly premiums.

Part B (medical insurance)

This Medicare part enfolds the out-patient services that are necessary such as visits to your doctor, medical equipment (durable), tests, lab services, ambulance services, mental health care, and services that are preventive of diseases. So, to simplify it, this part includes:

1)The diagnoses or treatment of medical conditions, and

2)The prevention or detection of diseases in their early stages.

By durable medical equipment, we mean the hospital equipment such as beds and walkers that are needed.

The Original Medicare has some out-of-pocket expenses that have to be paid by you. These include copayments, deductibles, and coinsurance.

Part C (Medicare Advantage)

Individuals who are enrolled in Medicare Part A and Part B explained above can enroll in Part C or the Medicare Advantage. However, if you have ESRD, then you might find yourself ineligible under certain circumstances. This plan is basically given out by the private health insurance companies who have been approved by the Medicare.

Joining Part C mean that you have the privileges of Part A and Part B and that you still would have to pay the premiums for the Part B but with some extra benefits entitled to your name. This means in simple terms that Part C = Part A and Part B.

The additional benefits that are offered contain the dental, vision and hearing care. However, to get these benefits, you’d have to visit certain doctors and certain hospitals complying to their ‘networks’.

Medicare Advantage can be better than the previous two parts when it comes to pricing. This part has low out-of-pocket costs and they also depend on the type of plan you choose to purchase.

Part D (Prescription Drug Coverage)

As we stated above, the Original Medicare does not contain the prescription drug coverage. They only cover the expenses of the drugs either administered to an in-patient in a hospital or to an outpatient by a doctor. Thus, to cover the prescription charges of the drugs that have to be taken home, there is a stand-alone prescription drug coverage called Part D.

Before we can go into any details, it should be noted that if your Medicare Advantage Plan (Part C) cover prescription drug benefits then there is no need to enroll in this stand-alone program. Your plan then undoubtedly covers every benefit that can be given by Part A, Part B, and Part D.

Having said that, the people who can enroll in this part are those who already are receiving benefits from the Original Medicare. In case you fail to sign up for the Part D at the time fo eligibility and consider doing it later, then you’d have to pay the late enrollment fee. So, it is better to enroll when you are deemed suitable.

The benefit of Part D is that you receive help in covering the prescription charges as well as in lowering the costs in future.

Medicare Supplement (Medigap)

We have introduced all of the four parts to you; however, there are certain costs that are not covered by those parts and that is where Medicare Supplement comes in which can be purchased from private insurance companies.

The extra costs that we talked about are the ones that are to be paid outside the U.S. in a medical need or the out-of-pocket costs in the Original Medicare. In such circumstances, some of the costs are to be paid by the Original Medicare and some by the Medigap.

Now that you know about the different parts of Medicare, it is time to choose a plan for yourself. Even if by reading this article, you find it hard which plan to consider then there we can help you for free. 

We can help you choose the plan that suits your needs by checking the inclusion of your doctor and your prescriptions in a particular plan. Contact us now at 718-554-3425 and have a hassle-free experience.