When you become eligible for Medicare, many people wonder how their coverage works. Medicare was designed to deliver a basic level of coverage to those who can’t afford traditional private insurance or don’t have coverage from their place of employment. Unfortunately, like with any insurance, it has gaps, including the lack of coverage for medication or drugs, dental health, and vision supervision. So, to figure out how to fill these gaps, you’ll need to have a deeper understanding of Medicare, its parts, and your coverage.
Medicare Coverage Options
The main cover options for Medicare are the following:
- Original Medicare – which contains:
- Medicare Part A – Hospital Protection
- Medicare Part B- Outpatient Coverage
- Medicare Benefit (Part C, which takes over Part A, B, and most cases D)
- Medicare Part D (Medicine Drug Coverage)
- Medigap – Medicare Additional Security
Let’s take a look at the differences between each option.
Part A typically covers hospital visits, qualified nursing establishments, and clinical care. Medicare covers an approved amount for each type of service. Although there’s no monthly premium, you’ll need to meet a yearly deductible before Medicare covers the hospital expenses.
Part B covers doctor’s visits, home health services, lab tests, and x rays. This part is optional coverage and requires a monthly premium payment. Still, most people opt to add Part B because it will save you a significant amount of money over time.
Part C is also known as a Medicare benefit or a health plan. It is bought from a private insurance company which Medicare accepts. Part C applies for coverage from both Part A and B compiled into one program. Most of these parts also include medicare Part D prescription drug coverage.
Part D, as explained above, covers prescription drugs. This one is also an optional coverage and requires a monthly premium payment and copays for your medicine. Most Medicare Advantage (Part C) plans involve Part D coverage.
You should study your potential plan’s formulary and distinguish rates for the prescription drugs you need when shopping for Part D coverage. If you have health protection through your employer, you should obtain a letter letting you know whether your health plan meets the government regulations. If it doesn’t, you’ll need to sign up for Part D coverage.
If you want prescription drug coverage, you must sign up for Part D as soon as you are eligible for Medicare Parts A and B. If you don’t sign up, you will be charged a fee of 1 percent of the national average premium cost. This is for Part D coverage based on the number of months you didn’t have a creditable prescription.
Medical supplement insurance, also called “Medigap,” is a proposal that pays some of Medicare’s out-of-pocket costs, such as copays and deductibles. It also covers certain non-covered services. You must possess Medicare Parts A and B to buy a Medigap agreement. People who have Medicare Advantage plans do not need and cannot use Medigap coverage. If your employer covers your younger member, they provide health insurance and will be forfeiting that coverage when you resign.
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