When you enroll yourself or your family member in Medicare for long-term health coverage and protection, you are presented with their benefits and premiums. However, choosing one can be challenging since most of us can only afford one Plan, and some require special coverages. Nevertheless, we must understand what Medicare offers.
In this article, we will be covering a brief overview of what Medicare is and a breakdown of the most common medicare plans, namely Medicare A, B, C, and D. Read more below to see what Plan works for your needs.
Before you can start to compare quotes between plans, you must understand what the program is. By definition, Medicare is a government-backed health insurance program in the US. Medicare plans cover seniors, disabled individuals, and patients with complicated conditions, mainly end-stage diseases.
The program comprises many sub-programs or plans that cover many aspects of healthcare with varying costs for insured individuals. While this allows many patients to choose their plans concerning their medical status, it often causes confusion due to the complex nature of selecting plans.
Who Gets Qualified for Medicare
The medicare program has its eligibility criteria after their compatible plans. But in general, anyone who has lived in the US legally for at least five years can qualify for one of their plans. Specifically, enrollment is automatic for medicare plans A and B for anyone receiving social security benefits. As for other plans, they may fall under specific conditions, especially for those with disabilities and reaching 65 and above.
Let’s go over the different medicare plans and what they can cover for the insured.
Medicare Plan A: Hospital Insurance
Medicare Plan A generally covers hospital admission and inpatient costs. When formally admitted to a hospital, insurers are generally covered for up to 90 days for each benefit plus a 60-day lifetime reserve or buffer. Additionally, insurers can get up to 190 days of coverage in a Medicare-certified hospital.
Also, this Plan covers SNF of skilled nurse facility costs like admission of nursing equipment, wound care, tube feedings, and administration of medications from a skilled nurse. However, the qualification for this benefit is the insured has to spend at least three days as an inpatient within 30 days of admission to the SNF, and doctors require extended therapy or SNF-related services.
And in extended cases, home health care is also covered by daily or intermittent care. As for premiums, most people do not pay for Plan A, given that they or their spouse have 40 quarters of Medicare-covered employment. If not, you may have to pay around $278 to $500 monthly.
Medical Plan B: Medical Insurance
Plan B covers outpatient/medical coverage. From provider services to medical equipment to purchase or rent, ambulance services, although it differs whether the case is either non-emergency or medically necessary. Also, you can avail of preventive services like specialist screening and counseling costs on identifying and preventing diseases without coinsurance.
Remember that the Plan does not fully cover all services and is subject to fees and cost-sharing computations for Medicare-covered services. As for premiums, plan B usually starts at $160 per month but may be adjusted depending on the insurer’s annual income.
Medical Plan C: Medicare Advantage
Plan C is a flexible plan suited for those with Original plans (Plan A and B) but needing more services. To qualify for a Plan C, your Plan should have at least Plan A or B coverage, although the costs and restrictions can vary. Typically, you can combine Plan D with this should your Plan need prescription coverage.
Enrolling in medical Plan C also provides a unique membership card for your private Plan. That said, this could be an advantage to acquire services that need a combination of some benefits from your Original Plan and medical Plan D.
Medical Plan D: Prescription Plan Coverage
Plan D specializes in drug coverage and outpatient services provided through private insurance firms affiliated with the government. This means that this Plan is not directly provided by the government, unlike other plans.
Getting a Plan D coverage requires you to pick either a prescription-drug plan or a Plan C with drug coverage. Enrollment is optional, although it can help lower costs. That said, incorporating Plan D once the insurer qualifies for Medicare would be a good idea.
Whether you choose Plan D depends on your medical needs and circumstances. You may want to check and compare employee benefits and assistance programs to see what works.
Healthcare is essential and complicated; that’s why we take measures to research and understand the plans presented to us to get a healthcare program for your circumstances. The abovementioned plans should offer an idea of what coverage works for you.
Overall, it is a matter of understanding the insurer’s medical needs, history, and budget. The beauty of Medicare is that despite its complex procedures and programs, it only takes a good understanding and research to develop a plan that’s both effective and affordable for your family’s future.