Medicare Coverage

Your share of medical costs and related expenses can add up quickly. Our insurance agents can help simplify the process so you can choose the best combination of benefits for your physical and financial well-being.

Medicare has been serving older Americans and others for more than 50 years. It provides coverage for hospitalization (Part A) and doctor visits, surgeries and other services (Part B) and prescription drugs (Part D). Medicare was never intended to cover all medical services. Privately offered Medicare Supplement Insurance plans help cover costs that Original Medicare does not pay.

Choosing the plan that is right for you can be overwhelming. Check below for answers to some of the most frequently asked Medicare questions. Then get in touch with a Game Changing Benefits agent in your community to discuss Medicare Advantage plans, Medicare Part D prescription drug coverage plans and critical illness insurance.

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Original Medicare

Medicare helps millions of Americans pay for the health care services they need. The federally managed program covers people who are 65 and older, younger than 65 with certain disabilities, and any age with end-stage renal disease. It’s likely you have contributed to Medicare through Social Security taxes deducted from your paycheck.

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Medicare Advantage

Advantage plans are offered by private insurance companies that contract with Medicare to provide you with Part A and Part B benefits. Plans include Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), Private Fee-for-Service Plans, Special Needs Plans and Medicare Medical Savings Account Plans.

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Part D

Medicare Part D is Medicare’s prescription drug program. Established in 2006, the program consists of plans offered and managed by private insurance companies. Since the program includes different plans from different companies, it makes sense to shop for the plan that best meets your needs each year as plans change.

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Medigap Plans

Medicare Supplement Insurance policies, also known as Medigap plans, are sold by private insurance companies and can help pay some of the health care costs that Original Medicare covers, like copayments, coinsurance, and deductibles. Medigap policies also offer coverage for services that Original Medicare doesn’t cover.

FREQUENTLY ASKED QUESTIONS

Here are a few questions and answers to get you started. Visit gcbseniorinsurance.com for in-depth information and articles on specific topics.

“Original Medicare” is the government-managed program that includes hospitalization (Part A) and physician (Part B) services. Medicare covers laboratory tests, surgeries, doctor visits, some skilled nursing home care, and more.

It also covers supplies including wheelchairs and walkers when medically necessary to treat a disease or condition. You do not have to select a primary care physician, but your doctor must accept Medicare assignment.

For further information on how Medicare works, click here.

Original Medicare was never intended to pay 100% of your medical costs. Therefore, it can leave you with substantial out-of-pocket costs. Some reasons for this:

DEDUCTIBLES: Both parts A and B require deductible payments. These are cash amounts toward your bills you must pay before your benefits begin.

COINSURANCE: This requires you to pay a portion of medical costs. You will pay coinsurance for hospital stays more than 60 days. You will pay 20% of the Medicare-approved amount for most doctor services.

UNASSIGNED DOCTORS: If your doctor does not accept the Medicare fee schedule, you might have to pay the difference between the Medicare allowable and your actual bill.

“NOT COVERED”: Original Medicare does not provide coverage for certain services and expenses such as prescription drugs, “custodial” (unskilled) long-term care, hearing aids, treatment in foreign countries, and more.

Medicare Supplement Insurance is private insurance designed to help pay some of the costs Original Medicare does not pay. Also called “Medigap plans,” supplements are largely used to cover deductibles and coinsurance and can result in substantial savings. Click here for additional information.

Supplements are offered as standardized, identical plans. Although standardized, rates are determined by insurance companies, so searching for the best price is crucial to keeping your costs down. Supplements do not cover items that Medicare doesn’t cover like custodial care, dentures, routine foot care, most dental care, hearing aids and fitting exams.

Private companies offer Medicare Advantage plans to cover all of your health care needs. Medicare pays a fixed amount for your care each month to the private company offering you your Medicare Advantage Plan. However, each plan may charge different out-of-pocket costs and have different rules and procedures for how you get services (like referrals).

Medicare Advantage can provide extra benefits, such as routine dental and hearing. Medicare Advantage also has out-of-pocket maximums and allows you to avoid Original Medicare’s 20% coinsurance. The plans can take the form of HMOs, PPOs or other plan types, which often require you to stay within your network. They frequently have Medicare prescription drug benefits built into the plan.

Medicare Open Enrollment occurs every year from October 15 to December 7. Also called the Annual Election Period, this is a time for all Medicare Beneficiaries to re-evaluate their coverage and possibly move to or from Original Medicare, another Medicare Advantage plan, or a prescription drug plan (Medicare Part D).

Medicare Part D is Medicare’s prescription drug program. Established in 2006, the program consists of plans offered and managed by private insurance companies. Since the program includes different plans from different companies, it makes sense to shop for the plan that best meets your needs each and every year as plans change. Reasons why:

FORMULARY: Each Part D Plan has its own formulary (list of covered prescriptions). Make sure the plan you choose covers all or most of the drugs you need.

PREMIUMS: Different companies charge different premiums. You can find the best prices by shopping around, either on-line or speaking with an insurance agent.

Medicare.gov has an easy to use tool to help you find and compare Part D plans. Click here and then select Find Health and Drug Plans.

Medicare is a big part of life for most people age 65 and over. It can be your lifeline to good health.

There are many choices to be made, choices that can affect you every day.

The good news is Game Changing Benefits can help. We can guide you through a crowded marketplace and make the choice that’s best for your particular needs. We have access to many top companies and the plans they offer. If you want a Medicare Supplement, we make sure you find the best price available to you.

We’ll help you understand what Medicare is all about; whether Original Medicare and a supplement or a Medicare Advantage plan might be best for your needs and budget; or if a Part D (prescription drug) plan is right for you.

In other words, we will guide you through the entire Medicare landscape. The result can be better health and more peace of mind for you.