The essential ABCs
(and D!) of Medicare
The Medicare program
was designed in four parts, each part covering a different benefit category. As
a Medicare eligible person, you will likely need and use a combination of these
services depending on your health and as you get older.
Part A – Hospital
Coverage
Most people who
qualify for Medicare automatically get Part A coverage without having to pay a premium.
Part A includes inpatient hospital care, long-term care in hospitals and
treatment in a critical access hospital.
Part B – Medical
Coverage
Part B covers your
medically necessary doctors’ services and outpatient care. A premium for Part B
is deducted from your social security check each month to help pay the cost of
this coverage.
Part C – Medicare
Advantage Plans
If you have part C,
your coverage is provided by a private health plan called a Medicare Advantage
plan. The health plans are contracted with Medicare. The coverage includes
everything covered under Part A and Part B, except hospice care (original
Medicare continues to cover hospice care) and may include additional benefits
not available with Original Medicare.
Part D – Prescription
Drug Coverage
If you choose Part D
coverage, it can help lower your prescription drug costs. This coverage is
available as a stand-alone plan or may be included in a Medicare Advantage
plan. To learn more and have your questions answered, contact your local
licensed insurance agent. You may also desire to attend an upcoming Medicare
101 session taught by local area licensed insurance agents. To find one near
you, click here.
Choosing Coverage
Based on Your Health Needs
Choosing Original
Medicare Only. This means that you have Medicare Part A and/or Medicare Part B only.
Keep in mind, Medicare does not cover 100% of your medical and hospital costs,
which will require you to meet a deductible and then pay a percentage of the
cost of your care. Original Medicare also does not provide coverage for
prescription drugs. For this, you need an additional standalone plan that may
charge an expensive monthly premium.
Purchasing a
Medicare Supplement. The supplement provides
additional, variable coverage to fill in part or all the gaps or costs not
covered by Original Medicare, but the cost to you may be an expensive monthly
premium.
Selecting a Medicare
Advantage plan. A Medicare Advantage plan
(Medicare Part C) includes all the healthcare benefits you are entitled to
under Original Medicare, and may include coverage like vision, hearing, dental
and prescription drug coverage or provide monies toward over-the-counter
supplies. Some Medicare Advantage plans
may come with a $0 premium. Medicare
Advantage plans can, however, choose not to cover the costs of services that
are not medically necessary under Medicare. Medicare Advantage plans contract with the government to provide
coverage to you, so you are still in the Medicare program, but you don’t need
to use your Medicare card when you obtain medical services.
To learn more and
have your questions answered, contact your local licensed insurance agent. You
may also desire to attend an upcoming Medicare 101 session taught by local area
licensed insurance agents. To find one near you, click here.
Why Medicare Advantage May Be
A Good Choice for Patients Who Are Over 65
Many Medicare
Advantage plans offer benefits that are ideal for helping you afford good
healthcare coverage for current and future healthcare needs.
If you find that you
spend a lot of money on healthcare for things like specialist visits,
prescriptions and testing, a Medicare Advantage plan can help lower these costs
with affordable copays on these services. A copay is a set, fixed amount of
money that you pay as your share of the cost of care. You are still required to
pay a monthly Part B premium as part of a Medicare Advantage plan but may find
Medicare Advantage plans with premiums as low as $0 per month.
Wilmington Health participates
in a special program called Anchor Senior Care Advantage in partnership with Medicare Advantage from Humana. When you select one of these plans, you
have access to a new approach to care delivery that focuses on keeping you
healthy and helping coordinate care resources when you need them.
To learn more and
have your questions answered, contact your local licensed insurance agent. You
may also desire to attend an upcoming Medicare 101 session taught by local area
licensed insurance agents. To find one near you, click here.
What is Included in
a Medicare Advantage Plan?
Medicare Advantage
plans offer a variety of benefits designed to help members save on their
healthcare spending. An experienced advisor can help review the benefits of
each plan and help find the right one for you. One way to do this is to make an
appointment with a licensed agent, who can help you compare plans and
understand which providers belong in the network and what the cost of any
medications you are currently taking would be. If you see a healthcare provider
that doesn’t belong to the plan, your services may not be covered, or your
costs could be higher.
To find a plan that
is right for you and continue receiving care from your Wilmington Health primary
care physician, contact your local
licensed insurance agent. You may also desire to attend an upcoming Medicare
101 session taught by local area licensed insurance agents. To find one near
you, click here.
Medicare Advantage:
Saving on Hospital Care, Prescription Drugs and other Health Care Expenses
Receiving health
care at a hospital can be very costly. However, many Medicare Advantage plans
offer low copays on physician visits and include a limit on how much you pay
for these services.
Each Medicare
Advantage plan can charge different out-of-pocket costs, making it even more
important to compare benefits and find the plan that is right for your needs
and budget. Original Medicare does not cover prescriptions and adding a
supplemental prescription plan can often cost you more in monthly premiums. However,
many Medicare Advantage plans include prescription coverage for no additional
cost.
Medicare Advantage
plans can offer a number of benefits for you that are not offered in Medicare
Part A and B plans. They may include dental, vision and hearing coverage, as
well as additional benefits designed to help members save money and stay
healthy including:
- Exercise facilities
- Nutritional programs
- Transportation to and from medical appointments
- Preventative testing and care
- Over-the-counter medical supply allowances
To find a plan that
is right for you and continue receiving care from your Wilmington Health physician, contact your local licensed insurance agent. If
you don’t have an insurance agent, you may call (910) 518-5632 to speak with an independent licensed
insurance broker who is familiar with our practice and the plans that we are
contracted with. You may also desire to
attend an upcoming Medicare 101 session taught by local area licensed insurance
agents. To find one near you, click here.