For many Americans, healthcare is complicated and expensive.
For our Medicare members however, healthcare can be simple, affordable and remarkably caring.
Medicare is a federal health insurance program for eligible individuals U.S. citizens and legal residents, ages 65 and over and for some under 65 with a qualifying disability or with a diagnosis of end-stage renal disease or ALS.
Understanding Medicare can be overwhelming at first and as your healthcare partner, Clear Spring Health is here to help you wade through the mounds of Medicare information and help you choose the right plan for you.
It’s important to understand Medicare so you can make the right choices for your future health needs.
As you near the age of 65 and begin to look at your Medicare options with its different moving parts and pieces, it may simply seem overwhelming. We are here to break those parts down for you, so you can understand the differences between Medicare Parts A and B, Medicare Advantage Plans and Supplemental or Medigap plans. When you are armed with the right information you will be ready to choose the right plan to meet your healthy aging goals.
Medicare Part A covers hospital expenses and care such as inpatient stays, drugs, labs, equipment, intensive care, surgeries, and skilled nursing care.
You have plenty of time to sign up for Medicare: three months before your birth month, your birth month, and three months after your birth month. You have 7 whole months to make your decisions and enroll.
While most people don’t pay a premium for Part A, there are other costs to be aware of in the way of deductibles. Here are the cost facts for Medicare Part A:
Medicare Part B covers the cost of doctor visits, outpatient care, blood, and urine tests, medical equipment, and some preventative services such as physical and occupation therapy, diabetes screenings, and mental health care.
Here are some terms you should know when we talk about the cost of Medicare Part A and Part B:
Premium – A fixed amount you pay for coverage, usually on a monthly basis
Deductible – A set amount you pay for services before your plan begins to pay
Copay – A fixed amount you pay at the time you receive a covered service
Coinsurance – The amount you pay when the cost of a service is split with you, usually by 80/20 %
There are premiums and deductibles to consider when looking at the costs of Part B. Here are the cost facts for Medicare Part B:
Medicare Advantage plans (Medicare Part C) are administered by private insurance companies such as Clear Spring Health and offer extra benefits not available with Original Medicare.
Medicare Advantage plans consist of a network of health care providers that together provide you with additional benefits. Networks can be more efficient which results in lower overall health care costs. Some Medicare Advantage plans require you to use their network of providers. Others, such as Clear Spring Health, allow you to see the physician of your choice.
Before signing up for a Medicare Advantage Plan, you need to sign up for Medicare Part A and Part B and enroll in the Medicare Advantage Plan directly with the private insurer that offers the benefits that best suit your needs.
When you choose a Medicare Advantage plan, you will continue to pay a monthly Medicare Part B premium. While premium pricing varies, depending on the Medicare Advantage company you choose, many Advantage plans offer $0 premium plans and they also set the amounts for your deductible, coinsurance, and copays. You get an additional benefit with Medicare Advantage that is not available with Original Medicare: a limit on the annual amount you pay for your covered medical care (out-of-pocket maximum).
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Medicare Part D covers prescription drugs and is a stand-alone plan that is only available from private insurance companies if you choose to go with Original Medicare and would like to add prescription drug coverage (Parts A and B).
Every Medicare prescription drug plan has a list of drugs – known as a formulary, that are covered by the plan. While researching plans, be sure to compare your list of medications with the plan’s formulary to make sure your medications are covered.
The list of covered drugs is provided in accordance with a tiered formulary. Drugs are grouped into tiers based on cost and the lower the tier- the lower the cost. Deductibles are most often charged by tier as shown in the graphic below.
There are two ways to cover your prescription drug costs.
1. Purchase a Medicare Advantage plan that includes prescription drug coverage.
2. Purchase a stand-alone Part D plan to supplement your Original Medicare plan. Part D plans cannot be combined with Medicare Advantage plans. Like Medicare Advantage, Part D plans are offered by approved private insurance companies.
The cost of Part D depends largely on the plan you choose. You will pay a monthly premium and maybe a deductible. Out of pocket costs will also add to your Part D expenses. The costs of plans vary widely between the premium, drug prices and the list of drugs that are covered, depending on the tiered formulary.
Medigap plans are designed to help pay for costs that Medicare Parts A and B don’t cover, including copays, deductibles and coinsurance. You may combine Original Medicare, a Medicare Supplement plan (Medigap) and a separate Part D plan, but just like with Part D, you cannot combine a Medicare Supplement Plan with a Medicare Advantage Plan.
Medicare Part A and Medicare Part B are the equivalent of what is sometimes referred to as “Original Medicare”. Often, people who don’t have additional coverage through an employer, sign up for Parts A and B at the same time.
Original Medicare still does not cover all your healthcare needs. Refer to the chart below for what is not covered by Original Medicare.
You Have Choices.
You can choose Original Medicare (Part A plus Part B), a Medicare Advantage Plan (Part C), or you can add Part D for prescription coverage to Original Medicare, and/or a Medicare Supplement Plan (Medigap) for additional coverage of benefits that you need such as dental, vision, and prescription drugs.
Medicare Supplement Insurance Plan
*Offered by private companies
Medicare Part D Plan
*Offered by private companies
Combine Part A (hospital insurance) and Part B (Medical Insurance) into one plan
Usually includes prescription coverage
May offer additional benefits not provided by Original Medicare
Now that you are informed about Medicare and the differences between Original Medicare, Medicare Advantage plans Part C, Part D, and Supplemental plans you have the tools to make some decisions and choices. Consider your healthcare needs and how different plans will fit your healthy aging goals.
You are only committed to your choice until the next Annual Election Period, which is October 15 through December 7th and at that point you’ll be able to change your plan as your healthcare needs change.