Medicare Insurance and Medigap
Medicare is an insurance program funded by the government to provide health care coverage to people with limited income and resources. It covers people age 65 and older, as well as some children who are under age 26. It includes medical insurance (Parts A and B), prescription drug coverage (Part D) and disability benefits.
Medicare Part A helps pay for inpatient hospital services, some skilled nursing care, hospice care, home health care and some other medically necessary care. It also provides some preventive services and medical supplies.
Part B helps pay for doctor services, outpatient hospital care, durable medical equipment and certain home health care. It also covers some preventive services such as yearly mammograms and osteoporosis screenings.
It also pays a small portion of some medically necessary dental and eye care.
The main purpose of Medicare is to help cover a portion of your medical expenses, including deductibles and copayments. It is not intended to be a complete health care solution and is not a substitute for private health insurance or other forms of health care coverage.
Medigap (Medicare Supplement) is insurance sold by private insurers that helps pay some of the costs that Original Medicare doesn’t cover, such as deductibles and copayments. It can be purchased either as a stand-alone policy or as part of a Medicare Advantage (MA) plan.
Many insurers also offer Medigap on a group basis, allowing people to join a plan with friends and family. However, the premiums charged may be higher than those for standalone policies.
Another option is Medicare Advantage (Part C), formerly known as Medicare + Choice, which is available in many areas. These plans are governed by the Centers for Medicare and Medicaid Services.
These plans include both Part A and B, and they are sometimes referred to as all-in-one coverage. They are a good alternative to traditional Medicare.
In addition, most MA plans provide coverage for dental, vision and hearing. Some do not charge monthly premiums or fees, and most have low out-of-pocket expenses.
During the federal Open Enrollment period, you can review your Medicare coverage options, make changes to your existing plans and enroll in new plans. You can do this online through the CMS website or by calling a local Medicare assistance center.
A Medicare Advantage plan is a type of health plan offered by private companies that contract with Medicare to provide all your Parts A and B benefits. These plans typically have different networks and familiarity of coverage.
They can be very beneficial for people who don’t need a lot of medical care or who are self-employed and prefer to be in control of their health care. They can often be cheaper than Original Medicare and offer more choice in doctors, hospitals and other providers.
Medicare Advantage plans are financed by a payroll tax, general revenues and premiums paid by people with Medicare. Those with lower incomes and resources can qualify for assistance with their Medicare Part B premium or out-of-pocket costs through their state’s Medicare Savings Program.