Since 1965, Medicare has confused patients and doctors alike. But, each component of Medicare is actually pretty easy to explain.
If you need help understanding Medicare, you can also visit medicare.gov or have one of our licensed Medicare agents work with you.
Medicare Made Simple
Part A and B
Medicare Part A covers most of your medical care, including hospital care and short-term nursing care. Any health condition is covered for up to 100 days following diagnosis. The first 20 days are covered in full and the next 80s are covered with you contributing a deductible.
Medicare Part A costs nothing for patients.
If you need medical equipment, such as oxygen or a wheelchair, Part B covers it.
Medicare Part C is often known as Medicare Advantage. With Part C, you have the option to receive and/or buy your Medicare coverages through private insurance companies, instead of through the Federal government. The following companies offer private medicare insurances:
This includes your Medicare Part A and Part B and the insurance carriers often add additional services to Medicare Advantage plans.
Prescription drug coverage for Medicare patients is provided through private dental insurance companies. Some Medicare Advantage plans include prescription drug coverage and some do not.
The Federal government decides what drugs are or are not covered with Part D prescription plans.
A situation that can affect your prescription coverage is known as the “gap” or the “donut hole.” The gap is a limit on the total amount of prescription costs your plan will cover. Whether or not this will affect you is based on the medications that you might be taking and their cost.
However, once you cross into the prescription gap, you’ll automatically gain catastrophic coverage once your out-of-pocket prescription expenses reach a certain limit. This limit is reset each year.
If you have questions about Medicare coverages or want to evaluate your options, our licensed agents are ready to help you in any way we can. You’ll work directly with an agent and won’t be contacted by a slew of agencies.
Many qualified individuals choose Medicare Plan F or its high deductible version. With both Plan F options, you have coverage that fills in the gaps in other Medicare plans. The only difference with the high deductible version is that you’ll pay lower premiums because you pay out-of-pocket up to a certain amount before the coverage kicks in (In 2016, it’s $2,180).
So, you’ll have all the coverage of Part A and B, plus deductible coverage, plus coinsurance for skilled nursing facility care and foreign travel emergency coverage (up to a preset amount).
Plan F is a good example of why it’s so important to have a licensed agent working for you. Because the coverage is so comprehensive, it’s also more expensive. But, in weighing the costs, your agent will factor in your current and recent past healthcare needs, current prescriptions, etc., which may make Plan F the most cost effective option.
This plan is almost identical to Plan F, except that you’ll be paying the Medicare Part B deductible out-of-pocket (In 2016, it’s $166).
** Both Plan F and Plan G have an additional benefit. They also cover “excess charges,” the 15% premium, above published Medicare reimbursement rates, that a Doctor who is not a Medicare participant can charge for services.
Plan N is similar to Plan F, except that you aren’t covered for Plan B deductibles or excess charges, leaving these as out-of-pocket costs.
It’s very important to note that there is a 6 month “Medicare Supplement Open Enrollment” period that begins when you have Part B and are also age 65 or older.
During this period, you have “guaranteed acceptance” into Medigap policies. After this period, it’s possible that an insurance company can refuse to write you a policy based on current or recent health problems.
You also can not have both a Medicare Advantage plan and Medigap coverage. Medigap plans don’t include prescription coverage, so you’ll need a separate Medicare prescription drug plan if you choose Medigap.
Our agents know this and will work with you to ensure that you have the best possible and most affordable coverage available.
Find the best plans in Los Angeles, CA
Speak to one of our licensed health insurance agents.
Compare Different Health Insurance Quotes
from Top A+ Rated Carriers