Access to Affordable Healthcare
Learn more about different Medicare plans, the enrollment processes, eligibility, benefits, and more.
High-quality insurance at more affordable costs should be accessible for all individuals regardless of age. If you are a senior citizen or an individual with special needs, you can qualify for Medicare coverage for your health and well-being. Let’s discuss Medicare, its benefits, and whether you qualify.
What is Medicare?
Medicare is a federal program that offers individual health insurance based on age, disability, and/or a qualifying medical condition. The program is reserved for US citizens and other eligible individuals who have been living in the US for at least five years. In most cases, individuals must also meet one of the following criteria:
- Age 65 or older
- Younger than 65 with a qualifying disability
- Any age with a diagnosis of end-stage renal disease or ALS
Additionally, if you qualify for both Medicare and Medicaid, you are “dual eligible.” In cases such as these, individuals get to keep their Medicaid benefits and may get additional benefits from the Medicare program. If you are dual eligible, the two programs can work together to cover most of your health care expenses.
What is Medicare A, B, C, and D?
When enrolling in Medicare plans, individuals can choose to add additional coverage to meet their unique needs. Medicare Parts A and B are the Original Medicare plans that help individuals pay for doctor visits and hospital stays. However, Parts A and B do not cover everything.
- Part A: Part A helps individuals pay for hospital stays and inpatient care
- Part B: Part B helps individuals pay for doctor visits and outpatient care
- Part D: Part D plans provide additional coverage for prescription medications from doctors or other healthcare providers
- Part C: Part C plans are also known as Medicare Advantage plans and combine Parts A, B, and D. Some plans also provide coverage for routine vision and dental care. All-in-all, Part C functions like a regular healthcare plan with copays.
- Medigap: Furthermore, Medicare Supplement Insurance plans (also known as Medigap) can help individuals pay some of the out-of-pocket costs not paid for by Parts A & B
How Do You Enroll in Medicare?
Upon turning 65 or having Medicare eligibility, you are automatically enrolled in Original Medicare (Parts B). You also have the option to enroll in additional coverage as outlined in the steps below.
Step 1: Enroll in Original Medicare (Parts A and B). This is administered by the federal government.
Step 2: If you need additional coverage outside of Part A and B, you can review coverage plans with private insurance carriers.
- Option 1: If you elect to enroll in Part D, you can also add Medigap to help cover out-of-pocket costs that were not covered by Parts A and B
- Option 2: You can enroll in a Medicare Advantage plan (Part C). This option usually covers prescriptions (Part D) but may also include vision and dental coverage
Medicare Coverage begins the first day of your 65th birthday month as long as your enrollment has been completed during the first three months of your Initial Enrollment Period. If you delay signing up, your coverage could also be delayed. Furthermore, you could face 10% penalties (of your premiums) if you enroll in Part A and B late.
Work With Landel Insurance to Select the Right Coverage
If you have questions about the right coverage for yourself and your healthcare needs, the agents at Landel Insurance are ready to help. Insurance shouldn’t be complicated. Let’s make sure you are enrolled early to avoid delays or gaps in coverage.
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HMO Plans
HMO stands for Health Maintenance Organization.
In these plans, a patient’s medical coverage is restricted to a designated network, consisting of a group of physicians.
PPO Plans
PPO stands for Preferred Provider Organization, where an insuree is free to choose any doctor or physician they might want to consult for their health condition. This can include doctors within and beyond the scope of their network.
PFFS Plans
PFFS stands for Private Fee-for-Service plans. As the name suggests, this insurance plan consists of a process in which the federal government pays private companies to offer Medicare benefits for individuals.
SNP Plans
SNP plans for Special Needs Plans. According to this Medicare plan, people with specific diseases or health conditions are qualified to get SNP Medicare benefits. People in these groups can choose to customize their plan and its benefits according to their doctor’s recommendation and health condition.
D-SNP Plans
If you qualify for both Medicare and Medicaid, you are eligible for Dual-Eligible Special Needs Plans. You can get more benefits at no additional cost, such as dental coverage and routine services. There are allowances for groceries, over-the-counter products, and other health-related items. Additionally, as a part of Part D, you can also receive some prescription drugs at no cost.
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Learn More About Additional Medicare Coverage
Medicare and Medicaid are both government programs that help people pay for health care. However, Medicare is generally for people who are older or disabled. Medicaid is for people with limited income. It should also be noted that Medicare is governed by the federal government, while Medicaid programs are governed by the states individually. In some cases, individuals can be “dual eligible.”
We always recommend looking into whether or not you are eligible for additional financial assistance. If you are low-income, you could qualify for Medicaid, the Extra Help Program, Medicare Savings Programs, or the Program of All-Inclusive Care for the Elderly (PACE). Income accounts for money you get from retirement benefits plus any other money that you report for tax purposes. To learn more about eligibility for financial assistance you can speak with an agent at Landel Insurance or visit medicare.gov.
The following are excluded from Part A and B plans:
- Healthcare outside of the US
- Long-term care
- Hospital stays beyond set limits
- Routine Vision care
- Hearing exams or hearing aids
- Routine dental care
- Most prescription drugs
- Wellness benefits such as gym memberships
Have Additional Questions?
Landel Insurance can provide you with additional insights regarding your insurance questions. Please don't hesitate to contact us!
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