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Medicare is a government-issued health insurance program administered by the Centers for Medicare and Medicaid Services, or CMS. Servicing almost 50 million American citizens, Medicare is the largest health insurance provider in the nation.
Medicare is made up of four parts that each cover difference services: Part A, Part B, Part C, and Part D. Parts A & B are administered by the government, while Parts C & D are administered by private insurance companies.
There are several factors to consider when making health insurance choices. Having even a basic knowledge of Medicare and how it functions will enable you to choose a plan that is a good fit for you.
Part A is one part of original Medicare and covers inpatient hospital and skilled nursing care, hospice care, and home health care.
Most Part A members do not pay a premium for Part A if they or their spouse have paid Medicare taxes while working for at least 40 quarters (10 years).
Part B is the other part of original Medicare and covers medical services such as doctor visits and services that are needed to diagnose or treat medical conditions. Part B also covers preventive services as well as things like clinical research, ambulance services, durable medical equipment and limited outpatient prescription drugs.
Medicare Part C is also referred to as Medicare Advantage Plans. By law, a Medicare Advantage Plan must provide all the benefits of original Medicare but may include additional benefits not covered by Medicare, such as prescription drug coverage, hearing aids, vision, and dental. Medicare Advantage plans take the place of original Medicare and are administered by private insurance companies. You must be enrolled in Medicare Part A and B in order to enroll in this type of plan.
Medicare Advantage Plans are offered in specific service areas throughout the country. An individual must live in the plan’s service area in order to enroll in an Advantage Plan.
Medicare Part D is prescription drug coverage insurance. Prescription drug plans function similarly to employer or group coverage with the exception of the coverage gap or “donut hole,” which is part of every Medicare Prescription Drug Plan. The coverage gap is a change in the plan’s coverage once specific costs have been reached by the beneficiary and the insurance company. Generally, more expensive name brand medications cause a person to enter the coverage gap.
Medicare also offers a program called Extra Help, which can help pay for some to most of the costs associated with Medicare prescription drugs. This is a program for people with limited income and resources. You can determine your eligibility for Extra Help at www.ssa.gov.
Medigap plans work with original Medicare and can pay the portions Medicare does not cover, such as coinsurances and deductibles. You must have Medicare Part A and B in order to enroll in this type of coverage. Medigap plans do not cover prescription medications.
There are several standardized Medigap plans, each having individual benefits and rates concerning emergency care, coinsurance, copayments, etc. Working with a trusted and licensed Medicare insurance broker is the easiest way to choose a plan that is right for you.
Eligibility for Medicare is based on numerous factors. You may be eligible if:
The easiest way to enroll in additional Medicare insurance is through a trusted and licensed Medicare insurance broker. However, there are considerations you can make on your own:
The following are several reasons why Medicare may be a good choice for you during retirement: