By Casey M Brown 2021 AHIP Medicare Representative
As a national health program, the particulars of Medicare can be confusing. Let’s take a different approach to understand this benefit so you can know how it works. There are four parts or separate policies, Part A, Part B, Part C, and Part D.
Part A is used when you are admitted to a hospital and covers all drugs administered in the inpatient setting. Part A also covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Keep in mind some of the coverage isn’t a complete payment of that cost but it is a financial resource. This is why Carrier Insurance products are necessary in most cases.
Part B covers costs at your Primary Care Physician to some degree. That which isn’t covered can be covered partially by Carrier Insurance Benefits. Part B covers services or supplies that are needed to diagnose or treat your medical condition, medical equipment, mental health services in-out-partial hospitalization, and a limited selection of prescription drugs.
Part C is the Medicare Advantage Plan. This plan is an advantage as this is why CMS gave it the name. CMS realized that it is confusing to calculate your cost and since that is the case Beneficiaries vastly under calculated the coinsurances they agree to by purchasing a Supplement Insurance Plan. The advantage of the Medicare Advantage Plan is that the Carriers give a Max Out of Pocket Cost to Beneficiaries. This is the Carrier of the plan saying that the Beneficiary will stop paying at a specific dollar amount and the Carrier pays 100% of the rest of the Medical cost for the plan year. That’s knowing what you may say in the worst-case scenario. This is important to protect your retirement benefits and for some protecting their social security income. These costs can be controlled even more with Hospital Indemnity Insurance. Learn more about Hospital Indemnity Insurance by click here.
A plan with a max out of pocket allows the Beneficiary to purchase a Hospital Indemnity Plan that covers them for coinsurances so they can pay a premium monthly instead of paying from their bank accounts. Medicare Advantage Plans can include prescription drug coverage. MAPD but you can choose a plan that covers medical expenses only and pair it with your choice of Part D Prescription Drug Coverage and more.
Part D covers prescription drugs that you receive at your Pharmacy from your Doctor and some drugs that aren’t covered by Part B that your Doctor gives you at their office. Part D coverage has a formulary that places drugs at a particular dollar amount of percentage due to be paid by the Beneficiary. A Late Enrollment Period penalty will come if you are not covered by creditable prescription drug coverage after you are out of your Initial Enrollment Period. So be sure to look into getting one of the standard plans or some other creditable coverage. Creditable coverage is simply coverage that is expected to pay on average at the least as much as Medicare Standard Prescription Drugs Coverage.
A Quick Rundown…
Part A and Part B must be obtained before a Beneficiary can enroll in a Medicare Advantage Plan
So here’s a quick rundown of things to know about the parts of Medicare.
Part A is covering you (to a degree) while you are admitted to a hospital or nursing facility and some home care.
Part B is coverage from the cost a Beneficiaries Primary Care Physician charges and some prescription drugs they administer.
Part D is coverage for prescription drugs and there is a penalty for not having a standard Medicare Plan or the equivalent.
Medicare has a lot of parts and because of that, it can be a long process. Keep in mind Medicare realizes this and has provided. Part C as a solution to that problem.
If you find it difficult to know your benefits take the time to learn how easy it is to know your Medicare Advantage Plan. Contact one of our Medicare Professionals to schedule an appointment to hear about a plan today.
Beneficiaries who also have Employer coverage can lose benefits with their employer if they are enrolled in a Medicare Plan. Be sure to contact your HR representative to confirm if you will retain your benefits if you choose Medicare Part C, Part D, or a Supplement.
What Veterans Should Now About Medicare
Veterans that don’t receive coverage that is outside of the VA Network should get a Medicare Plan to be sure to be covered while away from the VA. The VA does let Veterans know that their coverage is only in the VA Network and the Veteran Beneficiary should obtain health care coverage. that covers the outside of the VA Network. View their information here.
Veterans Affairs Hospital Prescription Drug Coverage is considered creditable coverage. You can have your VA Doctor prescribe you the prescription drugs that your outside Doctor recommends.
Something You Should Know About Enrollment
Medicare AEP and OEP are just a couple of the most used enrollment periods. There are many others but the most important other than the commonly mentioned is the Special Enrollment Period which can save you money and is the best way to stay away from paying more than you need to. A Special Enrollment Period can be used in this situation if the Beneficiary’s health was to change and they were diagnosed with a disease for a condition that has extensive tests and procedures that will have the Beneficiary come out of pocket more than usual. Plans like the Special Needs Plan are available in some areas. Which has $0 copays and coinsurances in both medical cost and prescription drugs. They include the highest amount of coverage Medicare allows and the carriers give more to make their product more selected than others. Be sure to take a look at and save the PDF Guide on enrollment periods.
Medicare can be simple just get with the tone of our Silver Age Professionals that will inform you and test you throughout your relationship so eventually, you will get a good grasp on the benefits and if you don’t they will be there to answer. Get your Silver Age Professional of America today.
All of these parts can be pieced together to allow the Beneficiaries low cost and adequate coverage for their health needs. As your health changes your plan may need to change to keep you from having costs grow out of your control. Medical expenses are the leading cause of elderly finding poverty or bankruptcy. This can come from sticking with a plan that was purchased when the Beneficiary had better health. New plans with different benefits come every year and having a trusted Professional that will keep your health in mind when new plans are available. Then you need to take the time to see if you would benefit from the new plans or another plan that takes your medical conditions into considerations. Whatever you don’t set it and forget it” unless you want to have that outlook on how you have money come out of your account.