What To Know About Medicare Coverage

Written By Alla Levin
July 28, 2022

What To Know About Medicare Coverage

The US Medicare system is a government-run health insurance program that provides coverage to those 65 or older and those with certain disabilities. It also offers the limited range to younger people with disabilities, but they must have received SSDI payments for at least 24 months before their disability began.

Medicare covers all or part of the costs for doctor’s visits, outpatient hospital services, and prescription drugs. It does not cover long-term care services such as nursing homes. The Centers administer Medicare for Medicare and Medicaid Services (CMS), which limits certain benefits to individuals who are eligible based on age.

The Medicare system is funded by payroll taxes and general revenue. Payroll taxes are broken down into two parts: one part paid by the employer and one part paid by the employee. The public revenue funding comes from income taxes.

Plans for Medicare Coverage

The program provides health insurance for Americans who have worked and paid into the system. Medicare is divided into four parts:

  • Part A(hospital coverage) pays for inpatient hospital services such as general medical, surgical, and maternity care. Medicare Part A is subsidized by a monthly premium paid by those eligible for the program.
  • Part B – (medical coverage): Part B covers most outpatient services such as doctor’s visits, outpatient surgery, and lab work. The premiums for this plan are not taxed like Part A premiums.
  • Part C – It is the most common type of Medicare coverage and is also referred to as a Medicare Advantage plan or MA Plans. Private insurers offer these plans and provide all kinds of medical care.
  • Part D – (dental/vision coverage). also known as the Medicare Supplement Plan. These plans only cover some costs not covered by traditional Medicare, like copayments and coinsurance.

The Affordable Care Act, otherwise known as Obama Care, provides health insurance for Americans who are below certain income levels. Still, not everyone qualifies for Medicaid or the Children’s Health Insurance Program (CHIP).

To qualify for medicare coverage, you need to meet specific requirements. Medicaid is a federal-state program that provides healthcare services to low-income people and the disabled.

How to Apply for Medicare CoverageHow to Apply for Medicare Coverage

For many people, Medicare is the only option for health insurance, says a Medicare specialist from Clearmatch Medicare. Unlike private insurance, Medicare does not have deductibles or co-pays.

Three ways to sign up for coverage are online through the Social Security Administration website, by phone, or by mail.

The application process can take a few weeks to complete, and you will need to provide some personal information like your Social Security number and date of birth. You must provide your retirement benefit check stubs and income information if you are receiving retirement benefits.

Once your application has been processed, you should receive a letter confirming your enrollment in Medicare along with a card that includes your unique Medicare number, which is needed when scheduling appointments with doctors or hospitals.

If you are eligible, you will be asked a series of questions about your work history, your spouse’s work history, and whether or not you have other health insurance coverage to determine which plan is best for you.

What is a Medicare Advantage Plan?

Medicare Advantage is a health plan offered by private companies that Medicare has approved. These plans provide all the benefits of original Medicare, but some also offer additional coverage like dental, vision, and hearing benefits.

They are also known as MA plans or Part C plans. They have been available since 1997 and have been growing in popularity.

In 2015, about 27% of people with Medicare enrolled in a Medicare Advantage plan instead of Original Medicare alone. The number is expected to grow to 40% by 2023, according to estimates from the Centers for Medicaid and Medicare Services (CMS). This is because they provide more comprehensive coverage than Original Medicare alone at a lower cost than traditional insurance plans.

A Medicare Advantage plan pays for original Medicare and additional dental, vision, and hearing benefits. Costs are lower because the plans pay for some medical expenses that original Medicare does not cover.

For example, it typically covers hospitalization services, physician services, and lab tests.
Medicare and Medicaid Services. The government sets standards for how these plans must cover services and keep costs low.

The Pros of Medicare Advantage PlansThe Pros of Medicare Advantage Plans

Medicare Advantage Plans are a type of health insurance that provides coverage for medical services outside of the traditional Medicare plan. Private insurers offer these plans and offer additional benefits and protections not available under the traditional Medicare program. Here are the benefits of the plan:

  • The plans offer more flexibility in choosing doctors and hospitals.
  • They provide more benefits than the traditional Medicare program, including extra coverage for prescription drugs, dental care, vision care, hearing aids, mental health care, and other services.
  • They can offer lower premiums because they can negotiate lower drug prices with providers.
  • Some plans cover the cost of routine checkups, such as annual physicals and eye exams.
  • Members of Medicare Advantage plans typically have more access to specialists than those enrolled in traditional Medicare.

The Drawbacks of Medicare Advantage Plans

Medicare Advantage plans are not always the best option for seniors. There are cons that people should consider before enrolling in a Medicare Advantage plan.
The first con is that the premiums of these plans can be much higher than traditional Medicare plans.

The second con is that these plans don’t provide coverage for all the services offered by traditional Medicare. The third and final con is that these plans require you to pay a monthly premium, which can be quite expensive in some cases.

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