The essential ABCs (and D!) of Medicare
The
Medicare program was designed in four parts, each part covering a different
benefit category. As a Medicare-eligible person, you will likely need and use a
combination of these services depending on your health, and as you get older.
Part A – Hospital Coverage
Most
people who qualify for Medicare automatically get Part A coverage without
having to pay a premium. Part A includes inpatient hospital care and home
health after the hospital stay.
Part B – Medical Coverage
Part
B covers your medically necessary doctors' services and outpatient care. A
premium for Part B is deducted from your social security check each month to
help pay the cost of this coverage.
Part C – Medicare Advantage
Plans
If
you have part C, your coverage is provided by a private health plan called a
Medicare Advantage plan. These health plans are contracted with Medicare to
care for you. The coverage includes everything covered under Part A and Part B,
except hospice care (original Medicare continues to cover hospice care). Often,
the plans include Part D prescription benefits at no extra costs. The plans may
include additional benefits not available with Original Medicare, such as
vision, gym membership, transportation, and more.
Part D – Prescription Drug
Coverage
If you choose Part D coverage, it can help lower
your prescription drug costs. This coverage is available as a stand-alone plan
or may be included in a Medicare Advantage plan. To learn more and have your
questions answered, contact your local licensed insurance agent. You may also
desire to attend an upcoming Medicare 101 session taught by local area licensed
insurance agents. To find an event near you, click here.
Choosing Coverage Based on
Your Health Needs
Choosing only Original
Medicare means
that you have Medicare Part A and/or Medicare Part B only. Keep in mind. Medicare
does not cover 100% of your medical and hospital costs. You will be required to
meet a deductible and then pay a percentage of the cost of your care. Original
Medicare also does not provide coverage for prescription drugs. For this, you
need an additional stand-alone plan that may charge an expensive monthly
premium.
Purchasing a Medicare
Supplemental Policy. The supplement policy, also
known as Medi-Gap policy, provides additional, variable coverage to fill in
part or all the gaps or costs not covered by Original Medicare, and cost to you
may be an expensive monthly premium.
Selecting a Medicare
Advantage plan. A Medicare Advantage plan
(Medicare Part C) includes all the healthcare benefits you are entitled to
under Original Medicare and may include coverage like vision, hearing, dental
and prescription drug coverage, or provide monies toward over-the-counter
supplies. Some Medicare Advantage plans
may come with a $0 premium. Medicare
Advantage plans can, however, choose not to cover the costs of services that
are not medically necessary under Medicare.
Medicare Advantage plans contract with the government to provide
coverage to you, so you still have Medicare. To obtain medical services, you
will present an insurance member card instead.
To learn more and have your questions answered,
contact your local licensed insurance agent. You may also desire to attend an
upcoming Medicare 101 session taught by local area licensed insurance agents.
To find one near you, click here.
Why Medicare Advantage May
Be A Good Choice for Patients Who Are Over 65
Many
Medicare Advantage plans offer benefits that are ideal for helping you afford
good healthcare coverage for current and future healthcare needs.
If
you find that you spend a lot of money on healthcare for things like specialist
visits, prescriptions, and testing, a Medicare Advantage plan can help lower
these costs with affordable copays on these services. A copay is a set, fixed
amount of money that you pay as your share of the cost of care. You are still
required to pay a monthly Part B premium as part of a Medicare Advantage plan
but may find Medicare Advantage plans with premiums as low as $0 per month.
The
Toledo Clinic participates in a special program called Independence Health Senior
Care Advantage in partnership with participating Medicare Advantage plans. When
you select one of these plans, you have access to a new approach to care
delivery that focuses on keeping you healthy and helping coordinate care
resources when you need them.
To
learn more and have your questions answered, contact your local licensed
insurance agent. You may also want to attend an upcoming Medicare 101 session
taught by local area licensed insurance agents. To find an event near you, click here.
What is Included in a
Medicare Advantage Plan?
Medicare
Advantage plans offer a variety of benefits designed to help members save on
their healthcare spending. An experienced advisor can help review the benefits
of each plan and help find the right one for you. One way to do this is to make
an appointment with a licensed agent who can help you compare plans and
understand which providers belong in the network and what the cost of any
medications you are currently taking would be. If you see a healthcare provider
that does not belong to the plan, your services may not be covered, or your
costs could be higher.
To
find a plan that is right for you and continue receiving care from The Toledo
Clinic or Wood Health primary care physician, contact your local licensed insurance agent. You
may also desire to attend an upcoming Medicare 101 session taught by local area
licensed insurance agents. To find an event near you, click here.
Medicare Advantage: Saving
on Hospital Care, Prescription Drugs and other Health Care Expenses
Receiving
health care at a hospital can be very costly. However, many Medicare Advantage
plans offer low copays on physician visits and include a limit on how much you
pay for these services.
Each
Medicare Advantage plan can charge different out-of-pocket costs, making it
even more important to compare benefits and find the plan that is right for
your needs and budget. Original Medicare does not cover prescriptions and
adding a supplemental prescription plan can often cost you more in monthly
premiums. However, many Medicare Advantage plans include prescription coverage
for no additional cost.
Medicare
Advantage plans can offer a number of additional benefits for you that are not
offered in Medicare Parts A and B (Original Medicare). They may include dental,
vision, and hearing coverage, as well as extra benefits designed to help
members save money and stay healthy, including:
- Gym membership
- Nutritional programs
- Transportation to and from medical appointments
- Over-the-counter medical supply allowances
To
find a plan that is right for you and continue receiving care from your physician
at The Toledo Clinic or Wood Health, contact your local licensed insurance agent. If
you don't have an insurance agent, you may call 419-237-1002 (The Toledo Clinic patients) or 419-237-1023 (Wood Health patients) to speak with an independent licensed insurance
broker who is familiar with our practices and the plans that we are contracted
with.You may also desire to attend an
upcoming Medicare 101 session taught by local area licensed insurance agents.
To find one near you, click here.
Medicare Enrollment Periods
Initial Enrollment Period:
If you're eligible for Medicare when you turn 65, you can sign up during the 7-month period that begins 3 months before the month you turn 65, includes the month you turn 65 and ends 3 months after the month you turn 65.
Annual Enrollment Period:
Every year, Medicare annual enrollment period is October 15 - December 7. Medicare health and drug plans can make changes each year—things like cost, coverage, and what providers and pharmacies are in their networks. October 15 to December 7 is when all people with Medicare can change their Medicare health plans and prescription drug coverage for the following year to better meet their needs.
Medicare Advantage Open Enrollment Period:
Each year, there's a Medicare Advantage Open Enrollment Period from January 1 – March 31. During this time, if you're in a Medicare Advantage Plan and want to change your health plan, you can do one of these: Switch to a different Medicare Advantage Plan with or without drug coverage.
General Enrollment Period:
Every year, the General Enrollment Period (GEP) for Medicare occurs between January 1 and March 31. This is the time—and usually the only time—during which you can enroll in Medicare Part A and/or Part B if you did not enroll when you were first eligible to enroll. The coverage starts July 1 and you may pay late enrollment penalty.
To learn more about how Medicare works, you may also want to attend an upcoming Medicare 101 session taught by local area licensed insurance agents. To find one near you, click here.