A health insurance plan can be difficult to find if you’re looking for one that meets your needs and fits your budget. There are many policies available, and their descriptions can be confusing. Some people find it necessary to have more than one health insurance plan to manage gaps in coverage.
The Centers for Medicare & Medicaid Services (CMS) offers different Medicare plans that cover various aspects of health care, depending on your needs and ability to pay for certain services.
Who Is Eligible for Medicare and Medicare Advantage?
Medicare is for Americans who are:
- At least 65 years old
- Under 65 years old with certain eligible disabilities
- Of any age with end-stage renal disease (ESRD)
- Of any age with amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease
What Is Medicare?
Medicare is a national health insurance program within the CMS. It is basically broken into four plans, referred to as Part A, Part B, Part C, and Part D. Original Medicare is comprised of Part A and Part B. Those who are in the Original Medicare plan can join a Medicare Part D plan for drug coverage since Part A and Part B do not cover prescription drug costs.
Medicare Part A covers inpatient care in hospitals, skilled nursing facilities, and patients’ homes. This part of Medicare also covers hospice care.
Medicare Part B is medical insurance and helps cover things such as:
- Outpatient care
- Services provided by doctors and other health care providers
- Health care offered in the home
- Durable medical equipment, such as walkers, wheelchairs, and hospital beds
- Some preventive services, such as vaccines, screenings, and annual checkups
Medicare Part D helps with the cost of prescription drugs, including recommended shots and vaccines. You can participate in these plans in addition to basic Medicare coverage or have them included in a Medicare Advantage Plan.
A benefit of Original Medicare (Part A and Part B) is that you can go to any hospital or doctor in the US who accepts Medicare. Some members of Original Medicare get help paying for their out-of-pocket costs from a former employer, union, Medicaid, or by buying supplemental coverage, such as Medicare Supplemental Insurance, known as Medigap.
What Is Medicare Advantage (Part C)?
Medicare Advantage, also known as Part C, is a collection of Medicare-approved insurance plans offered by private health insurance companies. Part C plans include the benefits offered under Part A and Part B and usually Part D. These plans may have lower out-of-pocket costs than Original Medicare.
Like most private health insurance plans, you will likely need to use doctors and other health care providers in your plan’s network. This can present a problem if you get sick or injured while traveling or spend a significant amount of time outside your home state. But you may be able to get extra benefits, such as coverage for dental, vision, and hearing services.
Choosing the Best Medicare Plan for You
Before deciding whether to go with one of the dozens of Medicare Advantage plans, Original Medicare, or possibly getting an additional supplemental plan, thoroughly research and match the benefits of the plans with your health care needs. It is important to understand exclusions, deductibles, coinsurance, and copays to minimize out-of-pocket costs. To learn more about the benefits and costs of the many plans, you should contact a local health insurance broker, your state’s department of health and human services, visit the Medicare website, or the State Health Insurance Assistance Program (SHIP).
Our law firm is dedicated to keeping you informed of issues that affect seniors who may be experiencing declining health. We help you and your loved ones prepare for potential long-term medical expenses and the need to transition to in-home care, assisted living care, or nursing home care. Contact our office at (718) 979-7477 to set up a time to discuss planning opportunities.