NYC Insurance Blog

Finding a Medicare Plan that Meets Your Needs

Arguably, Medicare is the simplest way Americans can get health coverage. Medicare is an insurance program primarily for people over 65, dialysis patients, and young people with disabilities. Depending on their medical needs, Medicare beneficiaries have many options. However, choosing the right Medicare plan is difficult, especially if you do not understand the terminologies and acronyms used.

It is important to research well and seek help from an expert to find a Medicare plan that meets your needs. Our Agency has been helping people with their Medicare plans for over 20 years! Give us a Call Today!

There Are Four Parts of Medicare Plans:

1. Part A – hospital or inpatient coverage
2. Part B – medical or outpatient coverage
3. Part C – alternative ways of receiving medical care
4. Part D – prescription drug coverage

Typically, most Medicare beneficiaries choose Part A and Part B through Original Medicare. Beneficiaries with underlying medical conditions opt for other plans to supplement their health coverage. In this article, we will discuss the different scenarios and options to help you get a plan that caters to your medical needs:

All in one Affordable Medicare Plan

If you need prescription drugs besides other health care services like vision and dental care, the Medicare Advantage plan is the best option. Medicare Advantage, Medicare Part C, offers numerous health coverage services via private insurers at an affordable cost. It is important to research and compare plans from different insurers to ensure your doctors/specialists/physicians and prescription medication are covered. Typically, Medicare Advantage plans have an approved in-network list of doctors or specialists.

Medicare Plan that Covers a Chronic Medical Condition

You need the Special Needs Plan (SNP) if you have a chronic condition. SNP is eligible to:

• People who live in certain institutions like nursing
• People eligible for Medicare and Medicaid
• People with chronic or disabling conditions like HIV/AIDS, End Stage Renal Disease or dementia

It is important to understand that Medicare SNP covers similar Medicare Services as Medicare Advantage Plan. However, Medicare SNP also covers extra health services tailored to special needs, like additional days in a hospital. Usually, SNP uses a care coordinator to manage your condition and oversee your treatment plan. For example, if you have diabetes, a care coordinator can monitor your blood sugar level and recommend diet and exercise to help you stay healthy and physically fit.

If you have Original Medicare, but it Does not Cover All Your Costs

If you have Original Medicare but are still paying out of pocket, consider enrolling in Medicare Supplement Insurance (Medigap plans). A Medigap plan helps cover any health costs Original Medicare cannot cover, for example, coinsurance, deductibles, and copayments. Medigap plan offers you coverage regardless of location, with some plans providing coverage if you travel abroad. Let’s assume you have the original Medicare and then buy the Medigap plan; the Original Medicare will cover the healthcare-approved costs while the Medigap plan covers the extras like hospice care. With the Medigap plan, you will have peace of mind because you can get health care services from all providers who accept Medicare. However, if you need prescription medication, you must enroll in Medicare Part D because the Medigap plan does not cover prescription medications. Here are crucial things you need to know before buying a Medigap plan:

• You pay a monthly premium for your Medigap plan ($45 - $400) besides the monthly premium you pay to Medicare for Medicare Part B.
• You can apply for a Medigap plan even if you have a Medicare Advantage plan. However, you must leave the Medicare Advantage plan before the Medigap plan starts.
• You can buy Medigap plans from any licensed insurance company in your state.
• The Medigap plan is designed to cover one person only.
• You are guaranteed Medigap plan renewal, provided you pay the monthly premium. Therefore, the insurer cannot cancel your plan even if you have an underlying health condition.

It is important to know that Medigap plans do not cover hearing aids, eyeglasses, long-term care, vision/dental services, and private duty nursing services. Understanding your Medicare coverage choices is essential because it determines where you get health care and out-of-pocket costs. For example, with Original Medicare, you can access approximately all doctors and hospitals in the US. However, Medicare Advantage plans have network restrictions limiting your access to certain hospitals, doctors/physicians/specialists. Research well and seek help from an expert, if need be, to make the right choice. Give us a Call Today for us to Help You for FREE!

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