What is Medicare?

Sometimes Medicare and Medicaid get a little confusing. Medicaid is a federal program that provides insurance to low-income families. Generally, it covers the children in the household who are under 18, and adults if the income is low enough. Medicare, on the other hand, is the federal government program that provides health care coverage for anyone 65 years or older regardless of income. Those under 65 that are either disabled or have end-stage renal disease may get coverage, as well. Though the difference between Medicaid and Medicare may be confusing enough, it is also important to know and understand the different types of Medicare available to you.

Types of Medicare

When it comes to Medicare, you will come across the following types:

  • Part A: Covers inpatient care
  • Part B: Covers outpatient care
  • Part C: Covers all that A and B cover plus more
  • Part D: Covers approved prescription medications that you take at home

What Exactly is Medicare Part C?

Unlike Original Medicare, Medicare Part C, or Medicare Advantage, is not government funded. Instead, it is an additional and supplemental insurance that is purchased through private insurance companies. Not just any private insurance company can offer it, though. Those that do must renew contracts through the government every year. Due to this yearly renewal, you should expect some things to change in your plan. Below we discuss enrollment periods. If you find that you are unhappy with changes made to your plan, you can make your own changes during the specified open enrollment period.

An easy way for many to understand Medicare Advantage is for them to understand that it is basically Medicare Part A, Part B, and Part D mixed together, along with some additional benefits. There are different Medicare Advantage Plans, though, so it is not a one size fits all type of policy. It is important to speak to an insurance provider about your specific needs so that they can help you choose the right plan. For those looking for insurance companies in Louisville KY and surrounding areas, we here at Aines Carter & Associates are dedicated to finding the Medicare plan for your specific needs.

What All Does It Cover?

As previously mentioned, it covers a variety of situations and has a variety of plans. Therefore, an exact list cannot really be offered. However, there are a few basics that you can expect. Medicare Advantage starts by covering everything that Medicare Part A and Part B cover, then some extras. For instance, while Part A covers inpatient care in a hospital or nursing facility, Part C covers the same inpatient care and home health care. Part B covers outpatient costs such as routine and preventative services that are necessary to avoid illness and disease. This would include flu shots and other vaccines, mental health services, physical therapy, occupational therapy, and lab tests.
Medicare Part C covers all of those costs put may also include routine dental care, vision care, ear care, and even fitness classes. Prescription costs are also usually covered by Medicare Advantage, though some of these benefits will differ depending on the exact Medicare Part C Plan you have. To find out what all your plan covers, speak with your plan agent or review your plan summary of benefits. Aines Carter & Associates wants you to know everything your plan covers.

Different Types of Medicare Part C

There is a variety of Medicare Part C plans that offer different things, different premiums, and different out of pocket expenses. Some may cover more extensive services than other plans. Some offer premiums as low as $0. Out of pocket expenses often vary between plans. However, they all cap off at $6,700 per year.
Some Medicare Advantage Plans include:

  • Private Fee for Service Plans
  • Health Maintenance Organizations
  • Preferred Provider Organizations
  • Medicare Medical Savings Account
  • Special Needs

Applying for Medicare Part C

There are three different times in which you can apply for Medicare Part C: the Annual Election Period (aka Open Enrollment), the Initial Enrollment Period, and the Special Enrollment Period (SEP).

Annual Election Period

There is an annual open enrollment period in which you can apply for or make changes to your plan. This is known to run from October 15 to December 7 of each year.

Initial Enrollment Period

Like most insurance companies, you can often sign up for Medicare Part C initially even if it is not open enrollment, like when an employee is just starting a job. However, any changes made after that will need to be made during the open enrollment period.

Special Enrollment Period (SEP)

Under certain circumstances, like if you move to a new area that your old service plan does not cover, you are granted a Special Enrollment Period. Do not wait too long after a change, though, as your Special Enrollment Period will not stay open indefinitely. The sooner you take care of it, the better.

Who Is Eligible for Medicare Part C?

If you want to apply for Medicare Part C, you must meet at least the following criteria:

  • You must be enrolled in both Medicare Part A and Part B. Even though it may seem that you can simply drop Part A or Part B if you Medicare Advantage, that is not the case. In fact, if you drop either A or B, you will be dropped from Medicare Advantage.
  • You must live in the area of the plan’s service. When you apply, the address that is connected to your social security card it will determine whether or not you are in that plan’s service area.
  • Lastly, you must not have end-stage renal disease. Though Original Medicare does cover this, Medicare Part C does not.While these are the basics, some plans may have their additional requirements. This should all be laid out plainly when you sign up.

Choosing the Right Plan

Choosing the correct plan for you and your situation is important, but it can also be a monumental task. Insurance companies in Louisville KY that offer Medicare Part C plans are well versed in any necessary knowledge to help you choose the right plan. Let us do the heavy lifting so you can worry about more important things.

Questions to Ask

Before purchasing a Medicare Part C plan, there are a couple of things you need to be clear about. The first is what type of coverage you actually need. No, you cannot tell the future, but there are some basic types of coverage you are likely aware that you need. Be clear about those things so that as you shop for a plan, you can find the best one to cover you.

The second question to ask as you are looking at plans and rates is simply whether or not you can afford the maximum out of pocket expenses. Medicare Part C plans do require different premiums and out of pocket expenses. Before purchasing a plan, you should know the absolute maximum you would have to pay for the year if everything went wrong. Can your income cover that amount? If the answer is no, you should look into other plans that you can afford.

Costs to Expect

While the amounts that you must pay out will likely differ from plan to plan, there are some basic types of costs that you can expect to pay. These are the cost categories you should research about each Medicare Advantage plan while shopping and comparing:

  • Monthly Premiums- Basically, this is your monthly “bill”, similar to any other bill you must pay. The premiums might start at $0. It is important to note that $0 premiums does not mean the plan is free. Instead, the regular cost of the premium will be spread among other costs associated with the plan.
  • Deductible- Quite often, this will have to be paid before the insurance coverage even begins. Check the terms of the deductible prior to purchase.
  • Coinsurance- Some things may require that you have 20% coinsurance, though again, check the terms before purchase.
  • Up To OOP Max- Different Medicare Part C plans can mean varying out of pocket expenses for you. Fortunately, a maximum has been set at $6,700, so that is the most you should pay.
  • Medicare Part D- Note that any Part D spending is separate from Part C spending, so that will not be factored into your maximum out of pocket expenses.
  • Out of Network- If you go out of your plan’s network, you can expect to pay extra.
  • What to Do If You Are Denied Something You Need

You have the ability to file an appeal if there are any unfavorable terms or you are denied for a type of coverage you need. This includes prescriptions, supplies such as diabetes testing strips, services, or other products that you need. While there is no guaranteed outcome, the right to appeal is there. If the outcome is not favorable, speak with your agent about what other Medicare Advantage plan will cover those things and plan to make that change during open enrollment.

Medicare Part C plans can be extraordinarily beneficial to Medicare recipients, but it is important to make smart choices about the plan you choose. Your needs are unique to you, so your plan should be too. Stop by or contact Aines Carter & Associates to discuss what is available to you, and let us help you make the right choice for your health care needs.