Medicare

Medicare is a federal health insurance program for people in the United States who are 65 or older. It is also available for certain people younger than 65 with disabilities or people with End-Stage Renal Disease. There are a lot of moving parts to Medicare that offer different coverage options from higher up front costs and lower cost share to low up front costs and higher cost share at the time of use. *insert chart on parts of Medicare*. Let us walk you through understanding the different components of Medicare and how they work together.

Original / Traditional

Medicare Part A and Part B are also known as Traditional or Original Medicare.

Part A – (Hospital Insurance)

Helps cover:

  • Inpatient care in a hospital
  •  Skilled nursing facility care
  •  Nursing home care (not custodial or long-term care)
  •  Hospice care
  •  Home health care

Part B -(Medical Insurance)

Helps cover medically necessary and preventive services:

  •  Doctor services
  •  Outpatient care
  •  Home Health Services
  •  Durable medical equipment
  •  Mental Health services

Medicare Part C – Medicare Advantage Plan

Medicare Advantage Plans are an alternative way of obtaining Medicare Part A and Part B coverage. You must be entitled to Medicare Part A and enrolled in Medicare Part B to be able to enroll in a plan.

The plans are offered by “Medicare-approved” private companies, who must abide by the government CMS Medicare rules.

The plans can include drug coverage (Medicare Part D). The plans arenetwork based by health care providers and some allow for out of network coverage. To be eligible for the plan the Medicare Beneficiary must live within the plan’s service area.

Types of Medicare Advantage Plans:

  • Health Maintenance Organization (HMO)
  • HMO Point-of-Service (HMO-POS)
  • Medical Savings Account (MSA)
  • Preferred Provider Organization (PPO)
  •  Private Fee-for-Service (PFFS)
  •  Special Needs Plan (SNP) – D-SNP|C-SNP|I-SNP

Medicare Part D – Medicare Drug Coverage

Two ways to obtain Part D coverage:

  1. Part D can come as a stand-alone plan that can be added to Original Medicare, some Medicare Cost Plans, some Private Fee-for-Service plans and Medical Savings Account Plans. You must have both Medicare Part A and/or Medicare Part B to join a separate Medicare drug plan.
  2. Part D coverage can also be as part of a Medicare Advantage Plan

To be eligible for a Part D plan the Medicare Beneficiary must live within the plan’s service area.

Medicare Supplement (MEDIGAP)

Medicare Supplement Plans also known as “Medigap” are plans sold by private companies that helps cover “gaps” Original Medicare, Parts A and B, do not cover.

Those gaps can include: Copayments; Coinsurance; Deductibles

(2) Long Term Care:

  • Long Term Care Plans can offer protection against the depletion of retirement assets, along with keeping you in control of your own decisions.

What is Long Term Care (LTC)

Long Term Care (LTC) is a range of services and supports you may need to meet your personal care needs. It has been estimated that 70 percent of retirees above the age of 65 years, will need assistance with things activities of daily living (ADLs) during their years of retirement.

Activities of Daily Living (ADLS)

Provides help with:

  • Bathing
  •  Dressing
  • OEating
  •  Transferring
  •  Toileting
  • Incontinence

Long Term Care Planning is critical, especially since Medicare does not cover the costs.

The costs of Long Term Care vary based on geographical locations through the US, couple with the care setting, home versus facility along with the level of care required. Below is the table highlighting the types and costs of care, to help understand the projected estimations.