WE ARE DEDICATED TO INFORMING AND EDUCATING YOU ABOUT HEALTHCARE AND OTHER FINANCIAL SERVICES.
You want answers to your questions regarding insurance and financial products. Since selecting the best product to meet your needs can be complicated, we hope our information will help you understand your options.
Because your needs are varied and ever-changing, we continually monitor various government and private programs and products. We will update this site continually and are happy to keep you informed on changes. Be sure to complete the form on any of our pages so we can send a free guide and keep you informed in areas of interest to you.
To be eligible for Medicare, you must earn at least forty (40) quarters of employment. During employment, Social Security payments are deducted from your salary. The forty quarters will qualify you for Medicare Part A at no cost. If interested, you must be 65 years of age or possess certain disabilities as defined by Medicare. You can contact the Social Security Administration online or go to a Social Security Office in your community to sign up or ask questions. You may also work through a Medicare advisor who works for a private company. When you enroll in Medicare, you also enroll in the Original Government Medicare plan. However once enrolled, you can then choose a Medicare Advantage Plan from a private company.
For clarity purposes, Medicare Part A covers Hospital Care and Medicare Part B covers doctor visits and charges a monthly premium for its coverage. Individuals must accept or decline Part B coverage when applying. In addition, enrollment for the Original Medicare Plan in most cases must be at a certain time of the year.
When enrolled in the Original Government Medicare Plan, you can go to any doctor or hospital in the United States that accepts Medicare. The Original Government Medicare Plan does not maintain a formalized “network” of Doctors and Hospitals. To see a Doctor, Specialist, or healthcare entity, Medicare enrollees simply make an appointment.
The Original Government Medicare policy requires a monthly premium for Part B coverage, which covers doctors for medical care. Additional charges include deductibles, coinsurance, and co-pays. The Original Government Medicare plan does not include a maximum out of pocket expense cap on healthcare coverage. However, with the Original Government Medicare plan, you can purchase Part D drug coverage and a Medigap plan separately.
The Original Government Medicare Plan maintains services that continually stay the same. Basically, it covers medically necessary healthcare. The Original Government Medicare Plan does not provide coverage for prescription drugs; however, it can be purchased. With the Original Government Medicare Plan, you may want to purchase a Medigap plan to defray costs. Additionally, you may want to purchase the Medicare Part D Prescription Drug Plan. Medicare Advantage plans must offer a benefits package similar or at least equal to the Original Government Medicare Plan’s, Medicare Advantage must also cover everything the Original Government Medicare Plan covers.
Medicare Advantage plans offer additional services to the Original Government Medicare Plan. These services may include:
Health club memberships
Prescription drug coverage
Medicare Advantage (MA) plans provide a specific type of Medicare health insurance. To enroll in an MA plan, you must be enrolled in the Medicare program and purchase from a private organization. Those in the healthcare industry refer to this plan as “Part C” of Medicare or “MA Plans.”
MA Plans provide an alternative to the Original Government Medicare plan by offering additional coverage. Our guide will cover the pros and cons of MA Plans. It provides information about different options and why you may need this kind of insurance.
To enroll in a Medicare Advantage program, you must specifically request Medicare coverage through a Medicare Advantage Plan and have reached the age of 65. Age exceptions exist, but those are for individuals with special needs. When applying, you must enroll in the Original Government Medicare Plan, Part A, and B to qualify for the Medicare Advantage Plan. Medicare Advantage benefits are administrated and provided through a private insurance company and not the government.
For those enrolled in a Medicare Advantage plan, your health care will be provided at no extra charge by those in the specific network. Because Medicare Advantage is comprised of a network of health care professionals, sometimes you must obtain a new primary care doctor, obtain referrals to see health care specialists and obtain authorization for certain services. Some Medicare Advantage plans allow you to obtain care outside the network and allow payment directly to those health care professionals. If you travel out of the service area and need to see a health care provider, most Medicare Advantage plans will cover the emergency and urgent care required. The follow-up and continued care must be conducted in the service area.
In network medical staff can join or leave a Medicare Advantage network anytime during the year. The Medicare Advantage plan can change doctors and hospitals in the network at any time during the year.
Medicare Advantage plans do not contain a co-payments provision that exceeds those for the Original Government Medicare for chemotherapy administration services, renal dialysis services, and skilled nursing. All Medicare Advantage plans maintain a Maximum Allowable Out-Of-Pocket (MOOP) limit on the amount of cost-sharing they can charge for Part A and Part B services. Once the yearly limit of out-of-pocket expenses has been reached, you will incur no further health care costs for the rest of the year. Medicare Advantage plans may change benefits, premiums, and co-pays every year.
Medicare Advantage plans vary in cost, and thus, applicants should conduct all necessary due diligence.
Questions to ask:
Explain any additional monthly premium.
Does the plan charge for a yearly deductible?
Explain the charges for a visit or service (co-payments or co-insurance).
What does the health plan offer?
Explain the healthcare network.
Choosing a healthcare plan is no easy task, which is why most seniors seek the help of Medicare specialists who do not charge a fee. Make sure you understand what each plan offers, the restrictions if any, the cost of each plan, and how the plan may interact or interfere with any active health insurance plan.
For instance, if you retire and have health insurance, a possibility exists that you may lose your present coverage when purchasing a Medicare Advantage plan. Please note that your former employer could offer you a Medicare Advantage plan. With that, both you and the company receive a win-win.
During the process of choosing one of the Medicare plans, you should also consider buying a Medigap policy, a prescription drug plan. Make sure you are clear on premiums, deductibles, co-payments, and yearly out-of-pocket maximums for both plans. Since not all Medicare Advantage plans work the same way, the following needs to be included in due diligence.
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.
If you do not qualify for non-emergency ambulance transportation, there may be non-Medicare transportation services available in your 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.
While original Medicare does not cover gym memberships or fitness programs, these may be part of the extra coverage offered by Medicare Advantage Plans, other Medicare health plans, or Medicare Supplement Insurance (Medigap) plans.
It is possible your health insurance may include a free fitness membership for adults age 65 and older called SilverSneakers. SilverSneakers membership includes access to roughly 16,000 gym and fitness centers across the country. That means that there are more participating SilverSneakers locations than there are Starbucks.
Unlike Medicare Advantage plans, Medicare Supplement insurance plans do not typically include gym memberships. Medicare Supplement insurance plans may cover most of your Medicare Part A and Part B coinsurance and copayments, as well foreign travel emergencies.
Because these Medicare plan options are offered through private, Medicare-approved insurance companies, their availability and benefits may differ by location.
You may want to compare plans to see if one in your area offers coverage for health club membership costs. Feel free to contact our advisors, who are glad to explain your benefits and help you find an option at no charge.
Medicare Advantage Plans, sometimes called Part C, combine Original Medicare Part A and Part B into one complete plan. These plans are offered through private insurance companies approved by the government Medicare program. These plans may also offer extra programs and services not covered by Original Medicare, such as dental coverage. Some plans may also include Part D prescription drug coverage and vision.
Medicare Advantage Plans work similarly to traditional health plans in cost and coverage. For example, there are HMOs, PPOs, POS plans, and more. These can include deductibles, copays, and coinsurance, but not all Medicare Advantage Plans cover dental. Before you sign up, make sure to read the details of what the plan covers. If you want dental coverage under Medicare, then make sure the Medicare Advantage Plan you choose includes the dental coverage that fits your needs and budget.
Original Medicare is composed of Part A, which is hospital insurance, and Part B, medical insurance. The only instance in which Original Medicare might cover any dental work, is if you suffered a traumatic injury that also affected your jaw, teeth, or mouth and had to be hospitalized. Then, Original Medicare may cover some of that dental care. Understanding exactly what your plan would cover is important to know before accidents occur.
When it comes to dental and vision, only Medicare Advantage Plans (Part C) may offer coverage and not all of them do. The dental coverage is typically basic and could include:
• Teeth cleaning
• Routine X-rays
• And possibly more
Plans may differ based on the insurance company and even your location. Dental coverage often comes with limits on how many services are covered in a plan year, maximum cost allowances, and more.
A Medicare Prescription Drug Plan or a Medicare Advantage Prescription Drug plan may cover certain products related to vision care, like eye drops or other vision medications prescribed by a doctor.
Medicare Part B is medical insurance. Medicare Part B covers some vision care, but not routine vision exams. You are not covered for vision correction such as eyeglasses or contact lenses under Medicare Part B unless you need vision correction after cataract surgery. Medicare Part B also does not cover eye refractions.
Medicare Part B covers yearly glaucoma screenings if you are at high risk. High-risk patients include those with a family history of glaucoma, African Americans age 50 and older, Hispanic Americans age 65 and older, and people with diabetes. State-approved vision care specialists are the only providers that may perform yearly vision screenings for glaucoma. You pay the 20% Medicare coinsurance for the vision care costs approved by Medicare, subject to your annual Medicare deductible.
Medicare Part B vision benefits cover cataract surgery and the cost of the replacement artificial lens, as well as the cost for vision correction products, such as glasses with standard frames, following cataract surgery. You pay the 20% Medicare coinsurance for the amount approved by Medicare, subject to your annual Medicare deductible.
Medicare Part B vision benefits cover eye prostheses for patients with absence or shrinkage of the eye due to birth defect, trauma, or surgical removal. Medicare Part B also covers the polishing and resurfacing of vision prostheses twice per year under its vision benefits, as well as one enlargement or reduction in size of prostheses without documentation. Additional enlargements or reductions are only covered when medically necessary. Medicare covers the cost for vision prosthesis replacement if the vision prosthesis is lost, stolen, or irreparably damaged within the first five years.
Medicare Part B covers ocular photodynamic therapy, which is a treatment for patients with macular degeneration, a vision problem associated with age.
Medicare Part C (or Medicare Advantage) offers an alternative way to receive your Original Medicare benefits. Medicare Advantage plans are offered by private, Medicare-approved insurers. All private insurers must offer at least the same benefits as Original Medicare (except hospice care, which Medicare Part A covers), but they may include other benefits, such as routine vision, routine dental, and Medicare prescription drug coverage. When routine vision benefits are available through a Medicare Advantage plan, your premiums could be higher than those charged by Medicare Advantage plans that do not offer routine vision benefits.
Some Medicare Advantage plans include full coverage for routine vision exams, vision correction products, and other vision care. Review the specific Medicare Advantage plan’s vision benefits to be sure.
• The Medicare Advantage (MA) program provides more benefits than the government’s Original Medicare program. Additional coverage typically includes routine dental care, prescription drugs, hearing aids, routine vision care, and membership to gyms and fitness centers.
• MA plans maintain lower cost-sharing expenses than the original Government Medicare Plans. For instance, a Medicare Advantage Plan may require a co-payment of $10. The Original Government Medicare co-payment consists of 20% of the cost, which may exceed $10.
• MA Plans maintain maximum limits for out-of-pocket expenses. As a result, once a policyholder reaches the maximum, there are no further costs for any covered services. Moreover, this exemption will last for the remainder of the insurance year. Unfortunately, the original Government Medicare plan does not offer this very important benefit.
• MA Plans coordinate care among the health care providers.
• MA Plans serve as a “one-stop” center for all health and prescription drug coverage needs.
• There are a limited number of MA Networks to choose from. In most cases, if you go out of network for care without authorization or a referral, your medical care may not qualify for reimbursement and you may need to pay the costs yourself.
• Authorizations and referrals: Hospital stays, medical equipment, and visits to specialists all require a referral from the primary physician. Therefore, without authorization, medical care may not qualify for reimbursement and you may need to pay the costs yourself.
• Regional limitations: Most Medicare Advantage Plans require that you live within a network’s region for at least 6 months prior to enrolling.
• Plan Options: The available options for Medicare Advantage Plans will vary depending on the region and the approved plan providers.
This guide should help you have a better understanding of which plan will be better for you and your family. If you want the financial protection of a limit on healthcare spending and set costs for procedures, as well as prescription benefits and extra benefits like dental and vision all rolled into one plan, Medicare Advantage can be a great option depending on the cost difference.
Health insurance costs
For both the Original Government Medicare Plan and the Medicare Advantage Plan, you can always appeal unfavorable decisions regarding coverage of services. Different rules and regulations exist for each Medicare plan and you should look into details of their policy to understand certain deadlines.