Medicare Insurance - Policy Solver

What Is Medicare?

Once you turn 65 you’ll need to decide if you’re going to use Original Medicare (Parts A and B) and a Medicare Supplement Insurance Policy, Medicare Advantage plus a Medicare Supplement Insurance policy, or just get one or the other but not a include a Medicare Supplement Insurance policy.

Keep in mind, it’s highly unlikely that Original Medicare nor Medicare Advantage will cover all of your medical costs, so unless you have a Medicare Supplement Insurance policy, you could be stuck with big expenses that you’ll need to cover out of pocket.

When you qualify for Medicare, it’s usually Medicare Part A and Part B that you’re first enrolled in. Medicare Part A and Part B make up what’s commonly known as Original Medicare.

Medicare Part A generally helps pay your costs as a hospital patient.

Medicare Part B may help pay for doctor visits, preventive services, lab tests, medical equipment and supplies, and more.

Medicare eligibility begins when you’re 65 years old. Technically you can initially apply for it when you’re within 3 months of turning 65, and then that application period extends to 3 months after you turn 65. So, including the month you turn 65, there’s a 7 month initial application window. And yes, you do have to apply for it. After you’re approved, most people typically qualify for what’s know as Original Medicare, or Medicare Part A and Medicare Part B.

Medicare Part A generally helps pay your hospital costs associated you’re a stay for care.

Medicare Part B generally helps pay for more non-emergent medical situations including doctors visits, preventive health services, certain lab tests, medical equipment and supplies needed for particular conditions, and possibly other things.

What Is Medicare part a?

Medicare Part A is known as hospital insurance. Part A generally covers inpatient hospital stays, certain home health care related services, skilled nursing care, and hospice care. The way it works is Medicare Part A will pay most of the costs associated with the care, but you will typically have to pay a deductible, and a copayment or coinsurance. The specific plan you get will indicate the details of how it all works.

Do you have to pay A part a premium?

The general answer to that is no. Most people do not pay a monthly or yearly premium for Medicare Part A. But there are certain situations where you may have to. For example, if you worked at least ten years and were paying income taxes, then you won’t have to pay a premium for Medicare Part A. If you worked for fewer than 7.5 years, then as of 2021 you will general have to pay $471 per month in premium. If you worked more than 7.5 years, but less than 10 years, then as of 2021 your premium is $259. So basically the way it works is whether you pay a premium or not, and how much you pay, are depending on how long you’ve been working and paying taxes. We all fund Medicare through out taxes, so in a sense you get out of it what you pay into it.

What Is Medicare part b?

Medicare Part B is known as medical insurance that can be thought of similarly to what your ‘regular health insurance’ pays for while you’re working and under the age of 65. The following are examples of items and services it covers:

How much will you pay for Medicare part b?

In most cases you will pay 20% of the Medicare-approved amount for each item or service. A deductible may also apply. So again, it’s similar to how your private or regular health insurance works, whether it’s through Aetna, United HealthCare, or many of the other larger health insurance organizations.

Gap in Coverage

The good news is there are many things that will be covered between Medicare Part A and Medicare Part B. However there will also be many things and portions of many things that will not be covered. For example, extended illness requiring extensive and varied health care may force you to go out out pocket and pay large bills that won’t be entirely covered. Additionally, if you are sick a lot and need to take more than routine or infrequent trips to the doctor, some of your costs may not be covered. So a way that most people look to safeguard themselves against having exorbitant bills is by getting a Medicare Supplement Insurance policy to “close the gap” between the total costs are and what Medicare Part A and/or Medicare Part B will cover.

What Is Medigap?

Medigap is a term used to describe the “gap” between what Medicare will cover and what it will not cover. It is not an actual insurance policy. Medigap policies are used to pay bills for you, by covering out of pocket medical care costs you’d have to pay for on your own, which are not covered by Original Medicare. Medicare Supplement Insurance is a type of Medigap policy, and is used to either lessen the gap between your bills and what will be covered by Original Medicare, or it can close the gap entirely.

What Is Medicare supplement insurance?

A Medicare Supplement Insurance Policy is a form of Medigap. There are other ways to close the gap, and purchasing a private Medicare Supplement Insurance policy is one way to do it. But, really there’s nothing else more to it than just understand the terminology.

Why purchase Medicare supplement insurance?

Doctor Visits: How Medicare Supplement Insurance Plans can Help

Generally speaking, you’ll still need to pay a deductive and a copayment or coinsurance with Original Medicare, which means you’ll still likely have to pay some of your doctor’s visits and hospital visits out of pocket. And the reality is these costs can be high and drain your savings, especially if you go to the doctor a lot.

So, one way to help offset these costs is by purchasing a Medicare Supplement Insurance policy. If you know that you will be visiting the doctor multiple times a month, the amount you could save on copayments by having a Medicare Supplement insurance plan could exceed the cost of the additional insurance plan and so it can be worth it to you to have a Medicare supplement policy.

It’s hard to forecast whether this will be financially beneficial for everyone, but odds are that it could be. You could always purchase a Medicare supplement insurance policy, see how your health goes for a few years and what your doctor’s visits look like, and then decide to cancel it.

Hospitalization: How Medicare Supplement Insurance Plans may Help

If you have to spend a long time in a hospital, then having a Medicare supplement policy could save you a lot of money. If you are using Medicare and are hospitalized for 1-60 days, you pay $0 coinsurance for each benefit period under Medicare Part A (your hospital coverage), but between days 61-90, you would pay $371 per day in 2021 that you’re in the hospital, and at day 91 and beyond you would pay $742 coinsurance in 2021 per each lifetime reserved for each benefit period, up to 60 days over your lifetime. After that you pay 100% of the hospital costs. So the costs could really add up.

As an example, if you have a 70 day hospital stay, that would cost you $3,710 and a 95 day hospital stay would cost you $14,840, not counting the Medicare Part A deductible for 2021. If you had a Medicare Supplement policy this could save you thousands of dollars. And this generally doesn’t include other services like specialists, tests, or procedures. So the costs of extended hospital stays could be a fortune.

Durable Medical Equipment: How Medicare Supplement Insurance Plans may Help

Durable medical equipment is a fancy name for items including hospital beds wheelchairs, walkers, or other things needed to help provide care services. Things like this are typically covered under Medicare Part B and included as part of coinsurance. Similar to hospital stays and doctor’s visits, depending on the types of equipment needed and how long it may be needed (for example, a hospital bed that you may need to have in your home), the costs could be very high and will likely not be fully covered under Part B.

So, a Medicare Supplement Insurance plan could be a good way to help cover the gaps in cost. For example, a hospital bed that costs $2,000 might have a coinsurance amount of $400 (the Medicare Part B coinsurance is typically 20%). A Medicare Supplement insurance plan may pay for this coinsurance and save you the out of pocket costs. Of course, different plans have different basic benefits, so our agents will help you figure out the right plan based on your situation

What Is Medicare Advantage?

Medicare Advantage is an alternative to Original Medicare (Parts A and B). It is also known as Medicare Part C. Unlike Medicare Part A and Part B, which are offered by the government, Medicare Advantage plans are private health insurance plans that you can buy from a company as long as they are approved by the federal government. And Medicare actually pays your Medicare Advantage plan to cover your benefits. Medicare Advantage health plans (such as HMOs and PPOs) are legally required to offer at least the same benefits as Original Medicare, but can also include additional coverage as well.

Examples of additional coverage typically can include dental benefits, routine vision care, certain health or wellness programs, and prescription drugs. So, you might be able to get Medicare Advantage if you want it, and it might be better for you than Original Medicare, but it might not cover all of your needs so you should still research whether a Medicare Supplement Insurance plan can help you.

One benefit of Medicare Advantage plans is that you can get your prescription drug benefits (know as Medicare Part D) included under the same plan, instead of having to enroll in a separate stand-alone Medicare Prescription Drug Plan when you’re enrolled in Original Medicare. That helps make things a little easier. These Medicare Prescription Drug Plans are also known as a Medicare Advantage Prescription Drug plans, and they help simply things by allowing you to have your Medicare Part A, Part B, and Part D coverage through a single plan.

If you want prescription drug benefits, you should considering getting it through a Medicare Advantage plan that includes this coverage; you shouldn’t enroll in a Medicare Prescription Drug Plan, which typically works with Original Medicare. Medicare Advantage plan costs and coverage details can vary depending on the insurance company and county that you live in. Similar to Medicare, and Medicare Supplement, this is something we can help you determine.

Things To Consider

What to consider when making your choice:

There are several factors that can influence what type of health insurance program you should choose once you turn 65 and whether Medicare Supplement insurance is right for you. You should consider your health condition, current financial situation, future financial outlook, and your lifestyle to help you make the right decisions. We can walk you through a needs analysis as part of our free consultation. But the bottom line is for some people, traditional Medicare plus Medigap can work, and for some people a Medicare Advantage-only program can work. Here are some things to consider: