Get the Right Coverage
We have advantage plans, supplemental plans, and prescription plans available to anyone over sixty-five years old, or who has been disabled for more than two years and has been pre-qualified through the social security administration.
JN Insurance Agency, will guide you through the process of preparing for the qualification of these plans. We can help you understand this complex topic, navigate you through the process, and ensure you have the peace of mind knowing you have a plan that fits your needs and a plan that will be there when you need it most.
Understanding of Medicare coverage
Medicare is a national health insurance program in the United States for qualifying citizens and some permanent legal residents. Generally, a person sixty-five years or older qualifies for Medicare, based on employment records or that of a spouse. A person under the age of sixty-five can qualify for Medicare because of a disability. “Anyone who has been approved and has received Social Security disability income benefits for two years qualifies for Medicare Parts A and B.” If you have a child with serious health issues who is approaching the age of eighteen, it is important to determine whether he or she should register for Medicare. Under the Affordable Care Act you can also cover your child under your own policy until your child reaches twenty-six years old. Medicare has four parts; some are mandatory for enrollees, others are optional.
Part A: Hospital Insurance
Part A covers the costs of being in a medical facility. When you enroll in Medicare, you receive Part A automatically. For most people, there is no cost to receive Part A. Services covered under part A include tests, surgeries, doctor visits, home healthcare inpatient care in hospitals and skilled nursing facilities, hospice care, home healthcare services and inpatient care in a religious nonmedical healthcare institution – a facility that provides medical services that align with certain religious beliefs.
Part A is more complicated than often perceived. For example, in-home hospice care is covered, but Part A does not cover a patient’s stay in a hospice facility. Additionally, if you’re hospitalized, your Part A deductible is $1,316, as of 2017. If you stay for more than sixty days, you have to pay a portion of each day’s expenses. If you’re admitted to the hospital multiple times during the year, you may have to pay that $1,316 deductible each time. After spending sixty days in the hospital, you must pay $329 per day in out-of-pocket costs; this increases to $658 per day after ninety days. Once coverage runs out, you will have to pay the full cost of the remainder of your hospital stay.
Part B: Doctors, Tests, Etc.
Part B covers doctor’s services, medical equipment, outpatient care and home healthcare. Other examples of covered care include ambulance services, outpatient procedures, the purchase of blood, mammograms, cardiac rehab and cancer treatments. You are required to enroll in Part B if you do not have “credible coverage” from another source – an employer or spouse, for example. With Part B, you pay a monthly premium. If you do not enroll and you do not have credible coverage, you may be charged a penalty. According to Medicare.gov, the standard premium in 2017 is $134 per month for Part B coverage, with a $183 deductible. Once you receive Social Security, the premium is deducted from your social security check. Once you meet your deductible, you will pay 20% of the Medicare-approved cost of the service, provided your healthcare provider accepts Medicare assignment.
But beware – there is no cap on your 20% out-of- pocket expense. If your medical bills for a certain year were $100,000, you would be responsible for $20,000 of those charges, plus charges incurred under the Part A and D umbrellas. There is no lifetime maximum. “Chilling, and potentially devastating for chronic illnesses like cancer – the American Medical Association estimates that Medicare users without Medigap (see below) can spend 25% to 64% of their income on medical expenses,”
What’s a Medicare Advantage Plan?
You can get your Medicare benefits through Original Medicare, or a Medicare Advantage Plan (like an HMO or PPO). Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare. Medicare pays these companies to cover your Medicare benefits.
If you join a Medicare Advantage Plan, the plan will provide all of your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage.
What do I need to know about Medicare Advantage Plans?
There are the different types of Medicare Advantage Plans:
- Health Maintenance Organization (HMO) plans—In most HMOs, you can only go to doctors, other health care providers, or hospitals in the plan’s network, except in an urgent or emergency situation. You may also need to get a referral from your primary care doctor for tests or to see other doctors or specialists.
- Preferred Provider Organization (PPO) plans—In a PPO, you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. You usually pay more if you use doctors, hospitals, and providers outside of the network.
- Private Fee-for-Service (PFFS) plans—PFFS plans are similar to Original Medicare in that you can generally go to any doctor, other health care provider, or hospital as long as they accept the plan’s payment terms. The plan determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care.
- Special Needs Plans (SNPs)—SNPs provide focused and specialized health care for specific groups of people, like those who have both Medicare and Medicaid, live in a nursing home, or have certain chronic medical conditions.
- HMO Point-of-Service (HMOPOS) plans—These are HMO plans that may allow you to get some services out-of-network for a higher copayment or coinsurance.
Who can join a Medicare Advantage Plan?
You must have Medicare Parts A and B and live in the plan’s service area to be eligible to join. People with End-Stage Renal Disease (permanent kidney failure) generally cannot join a Medicare Advantage Plan.
How much do Medicare Advantage Plans cost?
In addition to your Part B premium, you usually pay one monthly premium for the services included in a Medicare Advantage Plan. Each Medicare Advantage Plan has different premiums and costs for services; it is important to compare plans in your area and understand plan costs and benefits before you join.
What do Medicare Advantage Plans cover?
Medicare Advantage Plans must cover all of the services that Original Medicare covers except hospice care. Original Medicare covers hospice care even if you are in a Medicare Advantage Plan. In all types of Medicare Advantage Plans, you are always covered for emergency and urgent care. Medicare Advantage Plans must offer emergency coverage outside of the plan’s service area (but not outside the U.S.). Many Medicare Advantage Plans also offer extra benefits such as dental care, eyeglasses, or wellness programs.
Most Medicare Advantage Plans include Medicare prescription drug coverage (Part D). In addition to your Part B premium, you usually pay one monthly premium for the plan’s medical and prescription drug coverage.
Plan benefits can change from year to year. Make sure you understand how a plan works before you join.
What’s Medicare Supplement Insurance (Medigap)?
A Medicare Supplement Insurance (Medigap) policy, sold by private companies, can help pay some of the health care costs that Original Medicare does not cover, like copayments, coinsurance, and deductibles.
Some Medigap policies also offer coverage for services that Original Medicare does not cover, such as medical care when you travel outside the U.S. 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. Then your Medigap policy pays its share.
8 things to know about Medigap policies
- You must have Medicare Part A and Part B.
- If you have a Medicare Advantage Plan, you can apply for a Medigap policy, but make sure you can leave the Medicare Advantage Plan before your Medigap policy begins.
- You pay the private insurance company a monthly premium for your Medigap policy in addition to the monthly Part B premium that you pay to Medicare.
- A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you’ll each have to buy separate policies.
- You can buy a Medigap policy from any insurance company that is licensed in your state to sell one.
- Any standardized Medigap policy is guaranteed renewable even if you have health problems. This means the insurance company cannot cancel your Medigap policy as long as you pay the premium.
- Some Medigap policies sold in the past cover prescription drugs, but Medigap policies sold after January 1, 2006 are not allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D).
- It is illegal for anyone to sell you a Medigap policy if you have a Medicare Medical Savings Account (MSA) Plan.
How to get prescription coverage
Medicare offers prescription drug coverage to everyone with Medicare. If you decide not to receive Medicare drug coverage when you first become eligible, you will likely pay a late enrollment penalty unless one of these applies:
To get Medicare drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and drugs covered.
2 ways to get drug coverage
- Medicare Prescription Drug Plan (Part D). These plans (sometimes called “PDPs”) add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.
2. Medicare Advantage Plan (Part C) (like an HMO or PPO) or other Medicare health plan that offers Medicare prescription drug coverage. You get all of your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage, and prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes called “MA-PDs.” You must have Part A and Part B to join a Medicare Advantage Plan.