Medicare Experts near Las Vegas, NV

Medicare Parts Explained

Medicare Comes in Parts - See Below

Medicare Experts | Part A — Medicare Experts - Part A

Medicare Part A - Hospital Insurance

Medicare allows you to choose how you get your Medicare coverage. There are 2 principal methods to get Medicare coverage once you are enrolled in Original Medicare (Part A and Part B): 1. Add a Medicare Supplement plan or 2. Enroll in a Medicare Advantage Plan (Part C). Most individuals will also need to add Medicare prescription drug coverage (Part D).

Medicare is an entitlement program and most U.S. citizens are eligible to enroll in Medicare for working and paying their taxes for a period of time (generally 10 years). If you fear you haven’t worked long enough to be entitled to Medicare benefits, then you may still be eligible to enroll but may have to pay more.

Original Medicare

Original Medicare includes both Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). Those who desire prescription drug coverage are required to join a separate Medicare drug plan – Part D.
Original Medicare stipulates that you can choose any doctor or hospital that accepts Medicare in the U.S. When you choose Original Medicare, you could also add Medicare Supplement Insurance (Medigap), Medicaid, or employee or union coverage, to help cover your costs.

Keep in mind that time is of the essence when you become eligible for Medicare drug coverage or Medigap coverage. You may have to pay more if you wait to get these coverages later. These premium penalties could haunt you for the duration of your time on Medicare. Speak with a Medicare Experts Professional now for information about Medicare coverage.

Medicare Part A Coverage

Medicare Part A covers inpatient care in a hospital, skilled nursing facility care, nursing home care, inpatient care in a skilled nursing facility that’s not custodial or long-term care, hospice care, and home health care.
When unsure if Medicare Part A will cover a medical service that you need, you can ask your health care provider if it’s covered. If they’re unsure and you accept the service, then you may be asked to sign a notice that states you’ll have to pay for the item, service, or supply if Medicare doesn’t cover it.

Medicare Part A doesn’t cover everything. Medicare may not cover the following items:

Acupuncture
Cosmetic surgeries
Custodial Care
Dentures
Eye examinations
Hearing aids and examinations
Most dental care
Routine foot care

If you require items, services, or supplies that your Medicare plan doesn’t cover, then you’ll have to pay for them unless you have additional insurance coverage or a Medicare health plan that covers them.

Medicare Part B - Medical Insurance

Medicare Part B (medical insurance) is a portion of the Medicare federal health insurance program. Medicare Part B covers medical services and supplies that are necessary for the treatment of a health condition. This could include outpatient care, preventive services, ambulance services, and medical equipment.

Medicare was created for people who are 65 or older, certain young people with disabilities, and people with permanent kidney failure requiring dialysis or a transplant, also known as End-Stage Renal Disease (ESRD).

Medicare Part B

Medicare Part B specifically covers medically necessary services and preventative services.
Medically necessary services are those services or supplies necessary to diagnose or treat a medical condition while meeting acceptable medical practice standards.

Preventive services are health care services that prevent illnesses and help to correct health problems early stages when treatment can be most effective. Medicare Part B works so that most pay nothing for most preventive services when they’re provided by a health care facility accepting Medicare.

Medicare Part B covers things like clinical research, ambulance and emergency transport services, durable medical equipment (DME), mental health support services, inpatient and outpatient services, partial hospitalizations, and limited outpatient prescription drugs.

Medicare Part B doesn’t cover eye exams, eyeglasses, contact lenses, acupunctural therapy, most prescription drugs, in-home health care services, hearing tests or hearing aids, dental examinations, teeth cleanings, x-rays, and other routine dental care.

Your Medicare coverage will be based on 3 important factors. Federal and state laws, national coverage decisions made by the government about whether Medicare Part B will cover your situation, as well as local coverage decisions made by companies in each state that process claims for Medicare. These companies decide whether something is medically necessary and should be covered in your area.

Medicare Part C - Medicare Advantage

Medicare coverage plans can become a bit complex and costly when you need a more in-depth service. That is why Medicare Part C is a hybrid coverage plan that includes Part A and Part B. This means that hospital insurance and medical insurance are included in this fusion program. A combination of the two allows you to have all the drug and health benefits you need within a single healthcare plan instead of a stand-alone plan. This allows for several cost-effective options for you to choose from and additional unique benefits not offered in other programs.

If you have more questions, work with a licensed representative who can help you get started on your Medicare Part C plan. Contact the Insurance Professionals of Arizona today to review your options.

Comparison of Medicare Part C Plans

Learn how a Medicare Part C Plan can work for you. As an alternative to Part A and Part B, Part C helps you gain the benefits of both programs.

Is Medicare Part C the same as Medicare Advantage?

Medicare Advantage and Medicare Part C are considered the same program. Both allow the convenience of having both the drug benefits and health facility care coverage within a single plan. This is a better alternative than the option of enrolling into the Medicare Prescription Drug Plan, which is an entirely different program for the purpose of covering prescription drugs. There are also extra benefits, such as dental coverage, health wellness programs, hearing and routine vision check-ups. This is something the original Medicare plan does not include. Beneficiaries must enroll through the Medicare Advantage plan with private insurance companies. All of these companies are contracted with Medicare. The Medicare Advantage plans have to provide the same coverage that an Original Medicare plan would cover, and Part A and Part B. This doesn’t include hospice care in Part A, however. To be eligible, you must be within the service area of the Medicare Advantage plan you want to enroll in. You have to be enrolled in Part A and Part B. Unless there is an exception, you cannot have end-stage renal disease to qualify.

Are Medicare Advantage Plans Bad?

While they have great flexibility, they often end up pricier than other programs. There is the possibility of unplanned out-of-pocket expenses that can occur. There are a lot of copay costs that can add up over time if you happen to fall ill. You save a lot when doing well health-wise. However, if you happen to get a very serious medical illness, then you will have to purchase medicines and services through the copay option. The only time you are able to switch back to the Original Medicare plan is during the Medicare open season.

Urgent care may not always be available due to rationing; there is also less flexibility regarding which hospital or doctor you can choose due to rationing. Some plans that have prescription drug coverage may ration high-cost medications.

It may be hard to receive coverage when not in your local region, where benefits aren’t as promised. Additionally, these plans are not always financially stable. That is because individual private companies have their own problems and sometimes abruptly stop coverage. If a company suddenly becomes insolvent, then the enrollees will have no one to provide for them. All enrollees have to follow the strict rules of the plan to receive coverage. These plans sometimes drop providers without notice and may also only be able to cover specific doctors.

What are four types of Medicare Advantage plans?

The most common types of Medicare Advantage Plans include the Preferred Provider Organization (PPO), Health Maintenance Organization (HMO), Private Fee-for-Service (PFFS), and Special Needs (NSPs) plans. These are the most popular but not the only kind of plans available as some private insurance companies provide more specialized options for applicants with unique needs.

Preferred Provider Organization
The PPO plan is offered by a private insurance company where there is a network of doctors and hospitals. If you use one of the doctors within this network, it costs a lot less. When you use a doctor outside of the network, it costs far more. Prescription drugs are typically covered in PPO plans.

Health Maintenance Organization
For an HMO plan, you receive services for providers except when it concerns an out-of-area urgent care service, an out-of-area dialysis, and emergency care. Some coverage plans may include out-of-area services, but it costs less when working with your network of providers.

Private Fee-for-Service
This plan is offered by a private insurance company but is much different from the Original Medicare plan and Medigap. In this plan, it is pre-determined how much in costs will go to doctors and hospitals. You decide how much you will pay when you receive care. While you can see any provider, the costs will be less if you work with a network provider. You can also go to any Medicare-approved doctor who will accept your payment plan terms. Prescription drugs might be covered, or you can join a Medicare Drug Plan with Part D coverage.

Special Needs Plan
This plan limits membership, and only people with unique diseases or characteristics can join. The drug formularies are more extensive and meet the needs of the individuals covered under these plans. You won’t be able to receive urgent or emergency care. Out-of-area dialysis is not covered under this program either.

Medicare Experts - Part D — Medicare Experts

Medicare Part D - Prescription Drug Coverage

Prescription drugs are an important component of medical treatment, and the costs can be coupled with your Medicare coverage plan. Medicare Part D specifically aids in the payment for prescription drugs. You may not currently need prescription drugs, but this type of coverage makes them more affordable if you ever do. There are different individual prescription drug plans that you can consider, and you can work with MEDICARE EXPERTS to discover which plan works best for you.

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