All about Medicare – Health Insurance Plan

Are you worried about your health in this pandemic?

How will you pay the bills if you get sick and need hospital care?

All these thoughts must be disturbing the peace of your mind.

Being older or having a disability means you do not have a strong immunity system. This makes you more prone to falling ill.

You are worried about becoming healthier again, and on the other hand, you are worried about the huge hospital bills.

How about you focus on your health and let Medicare take care of your hospital bills?

You must be wondering what Medicare is?

So, in this article, I will tell you all about Medicare Health Insurance Plan.

I will cover the following points:

  • What is Medicare?
  • Eligibility for Medicare
  • Parts of Medicare
  • List of Medicare Advantage Plans 2021
  • Medigap Plans 2021

Let’s begin.

What is Medicare?

In 1966, Medicare was launched as a national health insurance program in the United States. It is administered by the Centers for Medicare and Medicaid Services (CMS) which is a division of the U.S. Department of Health & Human Services (HHS). Medicare helps to cover a part of the health care expenses if you are eligible for the program.

Medicare is similar to Social Security as it is also an entitlement program. As a U.S. citizen, you can enroll in Medicare when you work and pay taxes for a minimum required period. But if you are not working, you can still enroll but have to pay more.

Eligibility for Medicare

You are eligible for Medicare Health Insurance Program if you fall under these categories:

  • A legal resident of the U.S. for at least five continuous years with 65 years of age or older
  • Have some disability even if you are not 65 years of age but have been receiving SSDI benefits for at least 24 months from the date of entitlement before becoming eligible to enroll in Medicare.
  • Have end-stage renal disease (that requires dialysis or a transplant) or amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease).

Parts of Medicare

Medicare Insurance Plans are categorized in four parts: A, B, C, and D.

1.   Medicare Part A

It covers hospital (inpatient only), skilled nursing (at least hospitalized for three days), hospice services, and some home health care. Under this plan you have to share the cost of your hospital bill as it does not cover the full amount. Under Medicare Part A, if you or your spouse have worked for at least 10 years and paid Medicare taxes while you worked, you’re eligible for premium-free Part A. Otherwise, you pay a monthly premium.

2.   Medicare Part B

It covers outpatient services like doctors’ office visits, blood tests, X-rays, diabetic screenings and supplies, and outpatient hospital care. Lab tests and services requested by your doctor are fully covered under this plan. And you just have to pay a monthly premium.

3.   Medicare Part C

Medicare Advantage Plan (previously known as Medicare Part C) is an “all in one” alternative to Original Medicare. They are bundled together covering Part A, Part B, and usually Part D. Also you get covered for services related to vision, hearing, and dental. Before signing up for this plan, the beneficiary must have Original Medicare insurance.

4.   Medicare Part D

It covers mostly self-administered prescription drugs.

Part A & B of Medicare insurance is also known as Original Medicare. Under Original Medicare, you have to pay a set amount for your health care (which is deductible) before Medicare pays its share. In case of coinsurance or copayment, Medicare pays its share, and you pay your share for covered services and supplies.

List of Medicare Advantage Plans 2021

Medicare Advantage is an alternative to Original Medicare. It gives extra coverage other than Part A and B. These plans are provided by private insurance companies under the guidelines of Medicare. Here is the list of Medicare Advantage plans that may be available in your area.

·      Health Maintenance Organization (HMO) Plans

Under an HMO plan, you have a network of doctors and hospitals that you may use, except for any emergencies. You will have a primary care physician and you will need referrals to see any specialist. HMO plans offer the lowest premium among all plans.

·      Preferred Provider Organization (PPO) Plans

In the PPO plan, you can visit health providers within a network that have agreed to see you at the terms of the contract of the plan. Though you have the flexibility of seeing a doctor outside the network but it will cost more.

·      Private Fee-for-service (PFFS) Plans

In this plan, you are allowed to see any doctor who agrees to accept the plan’s rules and payment terms.

·      Special Need Plans (SNPs)

SNP is designed for people with Medicare who have particular needs like severe chronic conditions or lives in a long-term care facility.

Medigap Plans 2021

Medigap is Medicare Supplement Insurance that pays for some of the healthcare costs that aren’t covered by Original Medicare, i.e. Copayments, coinsurance, and deductibles for Part A & B. This supplement insurance is sold by private companies. Such companies charge a monthly premium. The cost of Medigap varies according to different plans, the company from which you purchase your policy, and your location.

Medigap plans are designed under 10 different types called Medigap Plan A, B, C, D, F, G, K, L, M, and N. Each plan has different monthly premiums, level of coverage and areas. You can buy these policies from any insurance company in your state.

You are eligible to buy a Medigap policy on the following conditions:

  • You must have Original Medicare insurance.
  • Medigap plan only covers a single person so, in the case of spouses, they need to purchase separate policies.
  • Under federal law, insurance companies cannot sell Medigap to people under age 65.

With new Medigap Plans 2021, the Medigap plans C, E, F, H, I, and J are no longer available to those who are new to Medicare. The most sought after Medigap plans for 2021 will be Plan G, Plan N, and then Plan F. You can read more about these plans and details about Medigap Plans 2021. Some of the top Medicare supplement companies for 2021 include Aetna, Accendo, Mutual of Omaha, and Cigna.

Now you know all about Medicare and new things that are planned for 2021. If you have not yet enrolled yourself in one of the Medicare Health Insurance Plan then do that favor on yourself and have stress free life.