Having Trouble Navigating Medicare? We Can Help!

​What is Medicare?

Medicare has four main parts:

1. Medicare Part A: Hospital Insurance, which covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.
2. Medicare Part B: Medical Insurance, which covers outpatient care, doctor visits, preventive services, and some home health care.
3. Medicare Part C: Medicare Advantage, which is an alternative to Original Medicare (Parts A and B) offered by private insurance companies. It often includes additional benefits like vision, dental, and hearing coverage.
4. Medicare Part D: Prescription Drug Coverage, which helps cover the cost of prescription medications and is provided through private insurance plans.

Each part has different coverage and costs, and they can be used together depending on individual needs and preferences. 

What are 4 types of Medicare plans?

​The four types of Medicare plans are:

1. Original Medicare: This includes Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance). Beneficiaries receive coverage directly through the federal government.
2. Medicare Advantage (Part C): Offered by private insurance companies, these plans combine coverage from both Part A and Part B and often include additional benefits such as vision, dental, and hearing coverage. Some plans also include Part D (prescription drug coverage).
3. Medicare Prescription Drug Plans (Part D): These plans are provided by private insurers and help cover the cost of prescription medications. They can be added to Original Medicare or some Medicare Advantage plans.
4. Medicare Supplement Insurance (Medigap): Sold by private companies, Medigap plans help cover out-of-pocket costs not covered by Original Medicare, such as copayments, coinsurance, and deductibles. Medigap plans do not include prescription drug coverage, so a separate Part D plan may be needed.

What is the most popular Medicare coverage?

Medicare Advantage plans: because they often provide additional benefits beyond Original Medicare (Part A and Part B), such as vision, dental, and hearing coverage, and sometimes include Part D (prescription drug coverage). Medicare Advantage plans also often have lower out-of-pocket costs and a capped annual out-of-pocket maximum.

Medicare Supplement Insurance (Medigap): This is popular among those with Original Medicare who want to cover additional out-of-pocket costs such as copayments, coinsurance, and deductibles. Medigap plans provide added financial protection and predictability for healthcare expenses. Both of these options have distinct benefits, and the best choice depends on individual health needs, financial situation, and preferences for coverage.

What is the most basic Medicare plan?

The most basic Medicare plan is Original Medicare, which includes:

1. Medicare Part A: Covers hospital stays, skilled nursing facility care, hospice care, and some home health care.
2. Medicare Part B: Covers outpatient care, doctor visits, preventive services, and some home health care.

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Original Medicare provides essential healthcare coverage directly through the federal government and is available to all eligible individuals. It forms the foundation of Medicare coverage, with other options like Medicare Advantage (Part C) and Medicare Supplement Insurance (Medigap) offering additional benefits or coverage.

What does Medicare NOT cover?

Medicare does not cover certain services and items, including:

1. Long-Term Care: Medicare does not cover custodial care in a nursing home or assisted living facility, which is help with activities of daily living like bathing and dressing.
2. Routine Dental Care: This includes most dental procedures, cleanings, fillings, and dentures.
3. Vision Care: Routine eye exams, glasses, and contact lenses are generally not covered, though Medicare Part B may cover certain eye exams related to medical conditions like diabetes.
4. Hearing Aids: Medicare does not cover hearing aids or routine hearing exams.
5. Cosmetic Surgery: Procedures considered cosmetic or elective are not covered unless they are medically necessary due to injury or a specific medical condition.
6. Over-the-Counter Drugs: Medicare does not cover prescription drugs obtained without a prescription or certain non-prescription medications.
7. Alternative Therapies: Services like acupuncture, chiropractic care (outside of spinal manipulation), and most complementary therapies are not covered.

Additional coverage for some of these services might be available through Medicare Advantage (Part C) or other supplemental insurance plans.

Disclaimer: This article is for informational purposes only. There is no legal advice being suggested or proffered and the author assumes no responsibility or liability for the actions taken or not taken by the readers based upon such information.