Know the difference in medicare coverage and seek help if you don’t understand the differences.
A Medicare Advantage Plan (also known as Part C) is offered by a private insurance company and essentially replaces Original Medicare. “Private insurers have the ability to manage care in different ways, and that`s a big trade-off,” he said compared to the original Medicare. This includes Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Service Fees (PFFS) Plans, and Special Needs Plans (SNP).
Medicare supplement plans (commonly known as Medigap plans) are sold by private insurance companies to fill gaps in your original Medicare coverage. In 2018, 34% of people originally enrolled in Medicare had coverage through a Medicare supplement plan to cover part of the cost of approved services. Choose from 10 Medigap plans – all named with letters from A to N – that offer standardized coverage and help pay for deductibles, co-insurance, co-payments, and more. However, Medigap’s policy does not cover prescription drugs. You must purchase a Medicare Part D plan in addition to your Medicare Supplement plan.
Medicare Part A covers the following services:
Inpatient hospital care: This is care received after you are formally admitted into a hospital by a physician. You are covered for up to 90 days each benefit period in a general hospital, plus 60 lifetime reserve days. Medicare also covers up to 190 lifetime days in a Medicare-certified psychiatric hospital.
Skilled nursing facility (SNF) care: Medicare covers room, board, and a range of services provided in a SNF, including administration of medications, tube feedings, and wound care. You are covered for up to 100 days each benefit period if you qualify for coverage. To qualify, you must have spent at least three consecutive days as a hospital inpatient within 30 days of admission to the SNF, and need skilled nursing or therapy services.
Home health care: Medicare covers services in your home if you are homebound and need skilled care. You are covered for up to 100 days of daily care or an unlimited amount of intermittent care. To qualify for Part A coverage, you must have spent at least three consecutive days as a hospital inpatient within 14 days of receiving home health care. (Note: You can get home health care through Medicare Part B if you do not meet all the requirements for Part A coverage.)
Hospice care: This is care you may elect to receive if a provider determines you are terminally ill. You are covered for as long as your provider certifies you need care.
Keep in mind that Medicare does not usually pay the full cost of your care, and you will likely be responsible for some portion of the cost-sharing (deductibles, coinsurances, copayments) for Medicare-covered services.
Medicare Part B provides outpatient/medical coverage. The list below provides a summary of Part B-covered services and coverage rules:
This list includes commonly covered services and items, but it is not a complete list. Keep in mind that Medicare does not usually pay the full cost of your care, and you will likely be responsible for some portion of the cost-sharing (deductibles, coinsurances, copayments) for Medicare-covered services.
Medicare Part C plans cover Part A and Part B, and many also include prescription drug coverage (Part D) and other benefits not available with Original Medicare. That`s why, of the approximately 64 million people who applied for Medicare, nearly 22 million of them opted for Medicare Advantage plans. 1 For example, Original Medicare doesn`t have prescription drug coverage.
Medicare Part D, the prescription drug benefit, is the part of Medicare that covers most outpatient prescription drugs. Unless you have creditable drug coverage and will have a Special Enrollment Period, you should enroll in Part D when you first get Medicare. Each Part D plan has a list of covered drugs, called its formulary. All Part D plans must include at least two drugs from most categories and must cover all drugs available in the following categories: HIV/AIDS treatments Anticancer drugs (unless covered by Part B)