Medicare
If you are nearing your senior years, odds are you have questions about Medicare. It can seem confusing with its multiple parts, but we are here to clarify Medicare as briefly as possible.
Hospital Insurance
Medicare Part A provides you with hospital coverage. This covers things like inpatient care in a hospital, skilled nursing facility care, nursing home care, hospice care, and home health care. Most people pay no premiums for Part A: if you or your spouse worked and paid payroll taxes for at least 40 quarters (ten years), you receive premium-free Part A. You will still pay copayments/coinsurance and your yearly deductible.
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Medical Insurance
Medicare Part B encompasses medical coverage. This covers medically necessary and preventive services, including ambulance services, clinical research, durable medical equipment, and mental health care. For covered services and items, you will pay a copayment or coinsurance amount. You also owe monthly premiums and a deductible.
Additional Coverage
While Medicare covers a good portion of your medical expenses, there are a few important services left out. Original Medicare (Part A and B) has no prescription drug coverage, nor does it cover routine dental, vision, or hearing exams or products such as eyeglasses, hearing aids, and dentures. Additionally, Medicare only covers services in the U.S., except in a few specific circumstances.
Medicare Advantage plans, also known as Part C, are offered by private Medicare-approved companies to handle your Part A and Part B coverage. Medicare compensates these companies for taking care of your Medicare needs. Under Medicare Advantage plans, you may also have coverage for prescription drugs and dental, vision, and hearing. Coverage and costs differ by plan. These plans may have networks of healthcare providers, and getting services performed by in-network providers will be more affordable.
Medicare Part D is offered separately and operates as prescription drug coverage. All prescription drug plans are standardized and cover at least two drugs in the most commonly prescribed categories. It is important to find a plan that covers your drugs. Each plan creates its own formulary, or list, of covered drugs. These are ranked in tiers based on the price of the copayment they will charge when you refill them. Generic drugs will have lower copayments than name-brand, non-preferred, or specialty drugs. If you need medication that is not on your plan’s formulary, you and your prescriber can request an exception.
Medicare Supplement plans, also called Medigap, help to pay the expenses of Original Medicare. There are ten available plans, and they each pay a portion of your costs for Medicare Part A and B copayments, coinsurance, and deductibles. Six of these plans also offer 80 percent coverage for foreign travel emergency medical care. If you frequently travel outside of the United States, you may want to consider adding a Medicare Supplement plan.
Navigating Medicare can be a challenge, but the experts at Swisher Insurance are here to help. For all of your Medicare questions, reach out to a representative.
