Licensed representatives are often provided with contact information for seniors who have requested information from a carrier or other resource, so it isn’t unusual to hear from a local agent that you may not know. If you feel rushed to make a decision or asked to make a payment over the phone end the call. Otherwise it is likely the caller can provide quality information at no charge.
Medicare Part D (also known as Medicare Prescription Drug Coverage) will pay for some or all of your prescription drug costs. If you enroll in Medicare Part D and have limited income and resources, you may be able to get extra help from this program.
Medicare Supplement Insurance, also known as Medigap plans, provide private health insurance that covers original Medicare payment “gaps”. Medigap will pay for co-payments, coinsurance, and deductibles. Additionally, insurers with original Government Medicare see a benefit when purchasing a Medigap policy to supplement their Medicare benefits. Medigap policies will not work with MA plans so an enrollee would need to switch back to Original Government Medicare. Furthermore, please note that some insurers work for employers or unions that pay for additional insurance that a Medicare policy does not cover. The plans (which are known as F, G, K, L, M, and N) offer different benefits. While the benefits of each plan with the same letter designation are the same, some companies charge more than others for the exact same plan.
A special needs plan (SNP) is a Medicare Advantage (MA) coordinated care plan (CCP) specifically designed to provide targeted care and limit enrollment to special needs individuals. A special needs individual could be any one of the following:
- An institutionalized individual,
- A dual eligible*, or
- An individual with a severe or disabling chronic condition, as specified by CMS.
*Dual Eligible Special Needs Plans (D-SNPs) enroll individuals who are entitled to both Medicare (title XVIII) and medical assistance from a state plan under Medicaid (title XIX). States cover some Medicare costs, depending on the state and the individual’s eligibility.
Medicare is our country’s health insurance program for people age 65 or older. Certain people younger than age 65 can qualify for Medicare, too, including those with disabilities and those who have permanent kidney failure.
The program helps with the cost of health care, but it does not cover all medical expenses or the cost of most long-term care. You have choices for how you get Medicare coverage. If you choose to have Original Medicare (Part A and Part B) coverage, you can buy a Medicare Supplement Insurance (Medigap) policy from a private insurance company.
- Medicare Part A (hospital insurance) helps pay for inpatient care in a hospital or limited time at a skilled nursing facility (following a hospital stay). Part A also pays for some home health care and hospice care.
- Medicare Part B (medical insurance) helps pay for services from doctors and other health care providers, outpatient care, home health care, durable medical equipment, and some preventive services.
Other parts of Medicare are run by private insurance companies that follow rules set by Medicare.
- Supplemental (Medigap) policies help pay Medicare out-of-pocket copayment, coinsurance, and deductible expenses.
- Medicare Advantage Plan (previously known as Part C) includes all benefits and services covered under Part A and Part B — prescription drugs and additional benefits such as vision, hearing, and dental — bundled together in one plan.
- Medicare Part D (Medicare prescription drug coverage) helps cover the cost of prescription drugs.
Most people age 65 or older are eligible for free Medical hospital insurance (Part A) if they have worked and paid Medicare taxes long enough. You can enroll in Medicare medical insurance (Part B) by paying a monthly premium. Some beneficiaries with higher incomes will pay a higher monthly Part B premium.
As of 2020, Medicare Advantage plans are authorized to offer innovation benefits, including transportation to doctor’s appointments. Medicare Advantage is another way to get your Medicare Part A and Part B benefits through a private insurance company approved by Medicare. To find out if your plan covers this, or if you are eligible to add a plan including transportation please contact our advisors, who are glad to assist at no charge.
Original Medicare (Part A and Part B) generally does not cover transportation to get routine health care. However, it may cover non-emergency ambulance transportation to and from a health-care provider. You need to have a health condition diagnosed or treated and other forms of transportation could endanger your health. Your doctor must provide a written order verifying that ambulance transportation is medically necessary because of your health condition.
For beneficiaries who do not qualify for non-emergency ambulance transportation, there may be non-Medicare transportation services available in their immediate area through local organizations. For instance, your local Area Agency on Aging (AAA) may be able to help you find transportation to and from your health-care provider.
If you are eligible for Medicaid or Program of All-Inclusive Care for the Elderly (PACE), these organizations may also provide transportation for routine medical care. Visit www.Medicaid.gov or www.Pace4you.org for more information.