Medicare Insurance 101
Every US taxpayer becomes eligible for Medicare health coverage at age 65. Medicare has multiple parts, which address different needs in the senior population.
Part A is hospital insurance. Many inpatient services and accommodations are covered under A. As a taxpayer, you have paid for a portion of your hospital benefits through your tax contributions.
Part B covers doctor visits, outpatient procedures, diagnostic tests, home health care and some preventive services, as long as they are considered medically necessary. To receive these outpatient benefits, most seniors must pay a monthly premium.
Part C, also known as a Medicare Advantage Plan, is offered through private insurance companies that are approved by the federal government. An Advantage Plan combines your hospital and outpatient benefits in a single policy.
Advantage plans may also include other types of insurance, such as vision or dental coverage. The details vary from one insurance provider to another.
Some plans offer only federally subsidized benefits, while others extend your protection to include a wider range of services. Most plans require a monthly premium.
Medicare Part D assists seniors with the cost of prescription medications that are not covered under A or B. You can receive D benefits through a prescription drug plan, or PDP, which adds drug coverage to the basics of your federal coverage. You can also receive D benefits as part of an Advantage plan. Understanding the Medicare Part D basics will help you decide whether a PDP or Advantage plan is best for you.
To receive Part D benefits without paying a late enrollment penalty, you must apply for the program during the government’s open enrollment period. For seniors, this period occurs during the three months before and after your 65th birthday. There are special enrollment periods for adults who move out of their service area, live in a nursing home or need extra financial assistance.
Medicare Part A
Medicare part A cost is something that many people are interested in learning about when they are curious about getting the kinds of coverage that would be able to help her. In all honesty, the cost information from Medicare part B companies or other types of Medicare providers about this kind of health care is not that difficult to understand.
You just need to know a few of the basic aspects of how it works to get a better idea of how the Medicare part A cost operates and what it might be. Take a look at some of the information that comes along with the Medicare part A cost to get a better idea of whether or not it is something that is a fit for your needs.
However, before you learn about some of the basic incidents that come along with dealing with the Medicare part cost, you need to take a look at practical situations to get a better idea of how the coverage would work for you.
This situation is not an actual happenstance, but it is a potential incident that could happen with this particular brand of health care.
Part A Situation
Imagine you wake up one morning, and you are experiencing extreme pain in your abdomen. You feel like you are going to pass out, so you call the ambulance that makes their way to your home and takes you to the hospital. You are admitted to the emergency room but then are taken to a regular room and seen by a few doctors. After a while, some tests are run on you, and they determine that you have a very serious issue in your liver. They tell you that they are going to need to cleanse your system and then do some dialysis so that you can flush out the negative bacterial.
So, you stay in the hospital for about a week before they tell you that you should be alright to go home. Of course, you are still not feeling 100%, so you tell them that you would be alright staying one more night. That night, something happens to your liver and you have an upsurge of the pain. The doctors decide that you will need surgery. You go into surgery and they remove some infected tissue that had been causing the problem.
Finally, after nearly two weeks in the hospital, you are sent home with a clean bill of health. You feel great until you get a bill in the mail for your stay. Because you were in a private room with four doctors on your case for two weeks, your bill is upwards of $230,000.
Obviously, you probably do not have the money on hand to cover this bill. However, you do have the kind of Medicare that will help you. So, you submit your Medicare A cost information, and you end up only having to pay for about 15% of the total bill.
This means that your bill of $230,000 is reduced to around $34,000. Still a sizable amount, but it is in no way as large as the original bill that would have bankrupted most people.
Cost of Part A
You do not have to pay directly for Medicare part A coverage because it is social health care.
However, you do have a co-pay, which is the Medicare part A cost that you are responsible for.
If you get into a situation where you need to use it, then you will have to pay the Medicare part A cost by way of paying for a portion of the expenses incurred. If you never use your part A coverage, then you never have to pay for it.
It is important to remember all of these aspects so that you can determine your Medicare part A financial responsibility and how it works.
Medicare Part B
Medicare part B is are something that you need to look into if you are interested in coverage that extends beyond inpatient care. This can include outpatient care, medical equipment and other services deemed as medically necessary.
In doing this, you will be able to better determine what the value is of having Medicare part B coverage based on potential situations that might come about.
The best way to understand what the value of this coverage and Medicare part B providers is an example of a potential situation that might come about in your life.
A Part B Situation
Think about this; if you were to get sick one day and need to go to the hospital, you probably would do so relatively quickly. For the sake of brevity, let’s say that you go in the early morning to the hospital to see a doctor. So, you get there, and you wait in line to sign in, and then you wait for an hour or so to get into seeing a doctor.
Finally, he looks you over and orders a few tests. After a few hours of waiting and testing and waiting some more, he determines that it is just a minor infection that looked worse than it was and prescribes you some medication. Then, he sends you on your way. Now, you go to the office to get your bill, and they hand you a bill for $9,000. However, you only have to pay $1000 of it. How is this possible?
Because you have coverage through Medicare B providers, the price is stunted. Though you will not necessarily be able to get out of paying the full bill, you will get out of the majority of it.
Because you were in and out in a single day, you are considered an outpatient. This means that you did not have to occupy a room overnight and did not need the additional care for over a period of 24 hours.
Even if you were in the room for 23 hours and 50 minutes, you would still be considered an outpatient. As long as you were out by the time that 24-hour mark hits, then you will be covered by the Medicare part B provider coverage.
That is what this kind of Medicare will take care of; outpatient needs. Medicare part B providers will take care of the majority of the bill that will come about with an outpatient situation.
Of course, that is not to say that it is easy to get on the Medicare part providers list. You will have to do some paperwork and show them that you do qualify for it before they allow you to take part in it. It is just a matter of meeting the specifications.
With regular changes and requirement updates to these plans, we recommend discussing your options with a heath care advisor.
Medicare Part D
To receive assistance with prescribed drugs from your doctor, it is beneficial to have Medicare Part D coverage. This federally sponsored program was designed to give you the additional financial support for prescription medications that are not covered under Parts A or B.
As the costs of health care and prescription drugs increase, more seniors are turning to Part D for help in covering their medical needs. Insurance companies approved by Medicare issue this supplemental form of coverage to help you stay active and healthy in your senior years.
If you are eligible for Medicare A or B, you can apply for a federally subsidized Medicare Part D prescription drug program, or PDP, which provides coverage for medications only.
You also have the option to join a Medicare Advantage plan, which can cover both prescription medication and medical treatment, to benefit from the drug coverage provided by D. To find an affordable plan that complements your current health insurance benefits, compare quotes from trusted insurance providers that offer this valuable coverage.
Medicare Part D Benefits
Preparing for your health care needs as a senior citizen is as important as preparing for your financial requirements. If you’re anticipating retirement, or if you’ve already qualified for Medicare and you’re looking for ways to reduce your medical expenses, consider adding Medicare Part D to your personal health plan. With a Part D prescription drug program or advantage plan, you can cut the costs of your prescriptions and avoid lengthy struggles to obtain the medications you need.
Although Medicare Part D is funded by the federal government, plans are administered by private or government-sponsored insurance providers that are approved by Medicare.
To benefit from the advantages of this program, look for a plan issued by a reliable provider that offers affordable coverage to seniors.
The benefits you receive and the cost of your coverage will vary from one insurance company to another, and from one policy to another. When you request quotes from insurers, you can choose a plan that fits your medical needs and your budget.
Each Part D provider establishes its list of covered drugs. This list, or formulary, does not necessarily include all of the medications that Part D will pay for. If you rely on certain products to maintain your health and prevent disease, or if you have a family history of a condition that may require specific medications, make sure these products are included on your provider’s formulary.
When you’re planning your health care, remember that certain drugs are excluded from any Part D program.
Any product not approved by the Food and Drug Administration, or FDA, will not be covered. Off-label products or products that are not available with a prescription in the United States are usually not covered. Medications that you can pay for with A or B are not covered under Medicare Part D. A plan may also exclude vitamins and other supplements, products used for cosmetic reasons, cold remedies and other items.
Costs of Medicare Part D
Out of all the money that seniors spend on health care each year, prescription drugs make up a large percentage of those expenses. Whether you take medication to manage blood pressure, control cholesterol, keep your blood sugar stable or maintain your bone density, drugs for these and many other conditions are expensive. Although A and B cover much of the treatment you need, these federal plans probably don’t provide for all of your needs.
The cost of a prescription drug or advantage program depends on the extent of your coverage and your income.
The more extensive your benefits, the higher your premium will be. Because Medicare Part D is a federally subsidized program, income plays a part in the cost of your policy. If your modified adjusted gross income exceeds a certain level, you will pay more for coverage than a person with a lower income.
Comparison shopping is one of the best ways to find the most affordable coverage. Because premiums may vary considerably from one company to the next, comparing benefits and costs among several companies can save you a lot of money. You can request quotes from several providers by using the free online search features on our website above or by reviewing the providers in your area on our list of Medicare companies page.
With healthcare costs on the rise, every source of financial support can benefit your budget. More importantly, having affordable access to the prescriptions you need may make a difference in your health and improve your quality of life. If you’ve ever had to make the difficult decision of giving up a prescribed medication because it wasn’t covered under A or B, a Medicare Part D plan may give you the help you need to get the treatment you deserve.
Medicare Part D Reimbursement
Medicare part D reimbursement is something that you need to make sure that you know about if you want to make sure that you are not missing out on any of the key discounts or low-income subsidies that might come about with this unique type of coverage.
The best way for you to fully understand Medicare part D reimbursement options and how it works is to look at a situation that you might find yourself in that would cause you to use this kind of coverage. Take a look at this situation below to get a better idea.
Reimbursement Used in a Situation
Let’s say that you get sick one day and you go to the hospital to see a doctor. After a few tests and some questions that you have to answer, they give you a prescription for some medication that you will have to purchase. The medication, you know, is going to be relatively pricey because you had a friend that had to use the same medication and had to pay a lot of money in exchange for it. However, since there is no other alternative, you decide that you will need to go ahead and get it.
You get in your car and drive to the pharmacy, walk up to the counter and hand the pharmacist a prescription slip that you were given. He returns a few moments later with your medication, and you see that it has to be refilled at least three times and the D medication is going to be about eight dollars per pill with 50 pills in the bottle. You do the math and realize that it is going to be $400 for each bottle. So, you pay for the pills and leave.
When you get home you remember that you have the Medicare part reimbursement option. So, you contact your company and tell them the situation. They file you for Medicare part D reimbursement and, within a few days, you get a check for $310 as the Medicare part D reimbursement for the $400 that you spent on the medication.
This is because Medicare part D reimbursement will take care of the medication costs that you will have to pay for on a regular basis. This is the main benefit for Medicare part D; though you usually will use the coverage right at the pharmacy, it is not necessary since you can get Medicare part reimbursement through other means as well.
This also means that you will need to make sure that you check into all facets of the Medicare part D reimbursement before you go into the pharmacy. You need to make sure that you have this particular policy activated so that you do not try to make a Medicare D reimbursement claim only to find out that you cannot get any of the reimbursement.
Medicare Prescription Drug Coverage and Exclusions
As you cover the Medicare Part D basics, you’ll learn about the medications that are covered and excluded under your plan. Each PDP or Advantage program may cover different medications, which are listed in a document called a formulary. As part of learning the Medicare Part D basics of any plan, review the formulary to make sure that the medications you need are listed. Many plans also require that you fill your prescriptions at pharmacies in the plan’s network. A list of network pharmacies should be included in the Medicare Part D basics provided by the insurer.
Many insurers separate the drugs covered under the Medicare Part D basics into different tiers. Each tier usually represents a different level of cost. Drugs in lower tiers usually cost less than drugs in higher tiers. All medications must be prescribed by your doctor and authorized by your insurance provider to be covered. Vitamins, over-the-counter remedies, medications used for cosmetic purposes and certain other categories of drugs are excluded under the Medicare Part D basics.
If you need extra help covering the cost of your prescriptions, you may receive additional benefits through Social Security. Extra financial help is available to seniors who meet the government’s income requirements. If you receive extra help, you may be exempt from late enrollment penalties when you apply for a PDP or Advantage plan.
Once you’ve reviewed the Medicare Part D basics, you’ll be better equipped to choose the PDP or Advantage program that fits your needs. Because benefits and costs of these plans vary from one insurer to another, it pays to compare quotes from several providers before you commit to one policy. With the right plan, you can receive the health care you deserve at affordable premiums
For the most up to date details and requirements for Medicare coverage take a look at CMS.gov and Medicare.gov. As is often the case, government resource sites can be fragmented and confusing. If you are not able to find the details you need before securing coverage, be sure to check out our list of Medicare advisors and providers.