Medicare will usually pay a portion of the costs associated with covered medical expenses. Most people will also purchase a “Medicare Supplement Plan,” also known as a Medigap Policy, to help with the out of pocket expenses that fall under the deductible or coinsurance of original Medicare. Prescription drug coverage is referred to as “Part D” and is usually obtained separately. If you’re a California resident looking for a local Medicare health insurance company in Redding, you’ve come to the right place.
At age 65 most US citizens earn the right to enroll in Medicare. Eligibility is based on whether you have worked the minimum required amount and made the required contributions through payroll taxes over your lifetime. For people that don’t meet the requirement, they may still participate in Medicare but will have to pay more. In some cases it is also available to people under age 65 if they are totally disabled.
Medicare is a federal health insurance program that will pay for medical expenses such as hospitalization, surgery, and doctor visits.
Medicare has four parts:
Part A: Hospitalization and some skilled nursing
Part B: Expenses outside the hospital
Part C: – Medicare Advantage plans
Part D: – Prescription Drug plans
In most cases, once someone enrolls in Parts A and B of Medicare they will also purchase a Medicare Supplement or Medicare Advantage Plan to help cover costs not paid by Medicare. You should also enroll in a Part D plan.
Medicare Supplements, commonly referred to as Medigap Plans, are offered by Private Insurance Carriers and are meant to "fill in the gaps" after Original Medicare pays their portion of medical expenses. Examples of these gaps would be coinsurance, deductibles, and copayments.
For example, Medicare pays 80% after a calendar year deductible for certain covered medical expenses. Many Medicare Supplement Plans will cover the deductible as well as the other 20%. You must have Parts A and B of Medicare in order to purchase a Medicare Supplement.
Medicare Supplements are available in most states and each insurance carrier can offer up to 10 "standardized" plans denoted by the letters A through N.
Carriers do not have to offer all 10 plans, but they must at least offer Plan A and either Plan C or Plan F, if they choose to offer Medicare Supplement Coverage.
All Medicare Supplement plans must include the same standardized benefits. For example, the benefits included in Plan F with one carrier are identical to the Plan F offered by another carrier. The only difference is the cost that each carrier charges for the plan.
Medicare Supplement coverage is an excellent way to help pay costs not paid by Medicare. Understanding the plans and all options available doesn't have to be difficult and overwhelming. At Shasta Health Insurance Services, we will explain them to you simply and clearly so you can understand all the Medicare options!
Some people choose to enroll in Part C of Medicare, known as Medicare Advantage Plans, instead of being covered by original Medicare.
Medicare Advantage plans will usually cover everything that original Medicare covers. The difference is that the deductibles, copays, and coinsurance could differ from original Medicare benefits, so the amount you pay for medical expenses would be different depending on which plan you choose.
Medicare Advantage plans are usually extremely low cost and can be a good alternative to paying the premiums for both original Medicare and a Medicare supplement (also known as Medigap) plan. Some Medicare Advantage plans also include prescription drug coverage, which would eliminate the additional premium for a Part D plan as well.
Please keep in mind that Medicare Advantage plans are not currently offered in Shasta County.
Part D of Medicare provides coverage for prescription drugs. Part D plans are offered through private insurance carriers and the benefits can vary dramatically depending on the prescriptions you take. Plans are priced based on the level of benefits. Some plans have the maximum deductible allowed by government regulations and are relatively low cost. Conversely, other plans could have no deductible and cost considerably more. An important factor when comparing Part D plans is your prescription use. Each plan has its own specific prescription drug formulary and pharmacy network.
Because of these differences, it is very beneficial to have an experienced insurance agent who can help explain the plan benefits and make sure your specific prescriptions would be covered.
It’s important to enroll in a Part D plan at the same time you enroll in Medicare. If you don’t, a late enrollment fee will be added to future premiums unless you have qualified prescription drug coverage through another source, such as your employer.
FREQUENTLY ASKED QUESTIONS
What are the different parts of Medicare?
Medicare is made up in four parts:
Part A: Pays for inpatient hospital services, skilled nursing, and hospice expenses.
Part B: Pays for many eligible medical expenses outside of the hospital.
Part C: These are Medicare Advantage Plans, health plans offered by Private Insurance Carriers as an alternative to using Original Medicare. Some plans also include coverage for prescriptions.
Part D: Prescription Drug Plans offered by Private Insurance Carriers to help pay for prescription drugs.
Can I ever change my Medicare Supplement Coverage?
You may change to an equal or lesser plan with any carrier during the month of your birthday, or you may change any time during the year with proof of insurability. You may also change to a Medicare Advantage Plan during the open enrollment period, if available in your region.
If you still have questions or would like to make an appointment, contact Shasta Health Insurance.
Do you have additional questions about Medicare? Please contact us at Shasta Health.