Medicare is a federal government initiative that provides cover for a significant share of the ever-rising costs of healthcare. Most recently, Medicare has sponsored preventive care as part of the program. To avail of these benefits, eligible citizens (generally above the age of 65) must enroll and specify coverage. Medicare is broadly classified into original Medicare Part A and B, Medicare advantage plans part C, prescription coverage Part D, and supplemental or Medigap policies.
Here are a few points to consider before availing benefits under these Medicare plans.
Enrollment date
Know when to avail of the coverage. Enrollment starts three months before your 65th birthday and ends three months post the date. This means you will have a window of six months to understand and enroll for Medicare plans after thoroughly assessing your needs. Note that there is a lifetime penalty that gets added to the premium payable under Medicare part B if you miss the initial enrollment. Alternatively, a general enrollment period lets users sign up for Medicare benefits between the months of January and March each year. And only special circumstances specified in the program make it possible to avail Medicare insurance post the initial and general period.
Original Medicare (Part A & B)
Know your coverage with Medicare. Original care part A insurance only pays for hospital inpatient care, skilled nursing facility care, nursing home care, hospice care, and home health care. Part B further provides cover for any services and expenses that are deemed necessary for medical practice. Most recently, coverage for preventive care was also included in part B for diagnostic procedures that detect illness prevention in its early stages. This includes the cost of clinical research, ambulance services, medical equipment, and outpatient prescriptions.
Advantage and prescription plans (Part C & D)
Medicare advantage plans part C is a great alternative to original Medicare. Part C is offered by private companies and features a variety of HMO plans, PPO plans, PFFS plans, and special needs plans. Note that everything available under parts A and B is covered. Still, part C also includes a provision to pay for services and out-of-pocket expenses that are not covered under original Medicare. Part D additionally focuses on prescription costs for generic medications not covered under original or advantage Medicare plans.
Supplemental Medicare plans
Original Medicare, advantage plans, and prescription coverage aside, you can also get supplemental insurance, covering the costs not included in other plans. These are various policies that fill in the gaps in your health insurance and help provide all-round cover. These Medicare plans are again sold and fulfilled by private companies. Alternatively referred to as Medigap policies, there are ten supplemental plans made available by private insurance providers in most states. Plans A, B, C, D, F, G, K, L, M, and N all feature specific additions, coverage terms & conditions, benefits, and policy particulars that define the eligibility criteria. Aetna, Cigna, Mutual of Omaha, Manhattan Life, Bankers Fidelity, Blue Cross Blue Shield, TransAmerica, Anthem, United Healthcare, and combined are among the top private supplementals and advantage plan providers in the country.
Quality of care, choice of doctors/hospitalization, and travel benefits
Medicare primarily does pay for all that is deemed prudent and necessary under standard medical practices to provide quality healthcare. However, there are certain limitations when it comes to out-of-pocket expenses and travel reimbursement. This is also applicable to the hospitals and patient care facilities that form part of the network mentioned in your primary insurance and Medicare plans. Depending on the type of plan and the provider, you must confirm the list of eligible hospitals and medical facilities before choosing a plan.
