MEDICARE: WHAT YOU NEED TO KNOW

Medicare is a health insurance program for:

• people age 65 or older,
• people under age 65 with certain disabilities, and
• people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).

 

Medicare has:

• Part A Hospital Insurance - Most people don't pay a premium for Part A because they or a spouse already paid for it through their payroll taxes while working. Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits.

 

• Part B Medical Insurance - Most people pay a monthly premium for Part B. Medicare Part B (Medical Insurance) helps cover doctors' services and outpatient care. It also covers some other medical services that Part A doesn't cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.

 

• Prescription Drug Coverage - Most people will pay a monthly premium for this coverage. In January 1, 2006, Medicare prescription drug coverage became available to everyone with Medicare. This coverage is to help you lower prescription drug costs and help protect against higher costs in the future. Medicare Prescription Drug Coverage is insurance. Private companies provide the coverage. Beneficiaries choose the drug plan and pay a monthly premium. Like other insurance, if a beneficiary decides not to enroll in a drug plan when they are first eligible, they may pay a penalty if they choose to join later.

 

Medicare Advantage Plans

• Medicare Health Maintenance Organization (HMOs)
• Preferred Provider Organizations (PPO)
• Private Fee-for-Service Plans
• Medicare Special Needs Plans

 

When you join a Medicare Advantage Plan, you use the health insurance card that you get from the plan for your health care. In most of these plans, there generally are extra benefits and lower co-payments than in the Original Medicare Plan. Most Medicare Advantage Plans are managed care plans, usually a health maintenance organization (HMO) or a preferred provider organization (PPO) and you may have to see doctors that belong to the plan or go to certain hospitals to get services.

 

To join a Medicare Advantage Plan, you must have Medicare Part A and Part B. You will have to pay your monthly Medicare Part B premium to Medicare. In addition, you may have to pay a monthly premium to your Medicare Advantage Plan for the extra benefits that they offer. In 2022, the standard Part B premium amount is $170.10 (or higher depending on your income). However, some people who get Social Security benefits pay less than this amount.

 

What is Medicare Supplement (Medigap) Insurance?

A Medicare Supplement (Medigap) insurance, sold by private companies, can help pay some of the health care costs that Original Medicare doesn't cover, like co-payments, coinsurance, and deductibles.

 

If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Your Medigap policy pays its share.

 

A Medigap policy is different from a Medicare Advantage Plan. Those plans are ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits.

 

What you need to know about Medicare Supplement policies

1. You must have Medicare Part A and Part B.
2.  If you have a Medicare Advantage Plan, you can switch to a Medicare Supplement insurance policy, but make sure you can leave the Medicare Advantage Plan before your Medicare Supplement insurance policy begins.
3. You pay the private insurance company a monthly premium for your Medicare Supplement insurance policy in addition to the monthly Part B premium that you pay to Medicare.
4. A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you'll each have to buy separate policies.
5. You can buy a Medicare Supplement insurance policy from any insurance company that's licensed in your state to sell one.
6. Any standardized Medicare Supplement insurance policy is guaranteed renewable even if you have health problems. This means the insurance company can't cancel your Medicare Supplement insurance policy as long as you pay the premium.
7. Medicare Supplement insurance policies sold after January 1, 2006 aren't allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D).
8. It's illegal for anyone to sell you a Medigap policy if you have a Medicare Advantage Plan, unless you're switching back to Original Medicare.

 

Part D Prescription Drug Plans

You can sign up for Part D Prescription Drug Plans, which helps cover prescription drug costs, along with other components of Medicare starting three months before your 65th birthday.

 

It's important to do this on time because there's a permanent premium surcharge for enrolling more than three months after your 65th birthday if you don't have equivalent drug coverage from another source, such as a retiree plan.

 

What Does Vision Care Insurance Cover?

Vision care insurance usually covers a percentage of the following basic services:

• Yearly eye examination
• Eyeglass lenses
• Eyeglass frames
• Contact lenses
• LASIK and PRK vision correction procedures at a discounted rate

 

Your specific vision care plan may have a limit, such as annually or every two years on how often it will pay for lenses and frames.

 

Who Provides Vision Care Services?

Frequently, vision care plans (including those you buy or are provided by your employer) contract with eye care professionals. In some plans, you use a certain eye care provider and receive a discount on the services offered. However, most plans purchased from a vision care insurance company are PPOs (preferred provider organizations) where your eye care is managed by a network of eye care providers. In a PPO, you also can use out-of-network eye providers, but you must pay a greater share of the cost.

 

Choosing Dental Coverage

Types of Dental Insurance Coverage

Similar to medical insurance plans, dental insurance policies are often categorized as either indemnity or managed-care plans. The major differences are concentrated around out-of-pocket costs, choice of dental care providers, and how bills are paid.

• This information comes from www.cms.gov
• By contacting the phone number on this website you will be directed to a licensed agent.