Medicare Explained Simply
Assistance with health care has been a growing issue in the United States for years. Many individuals, especially seniors, find that they are unable to afford medical bills or insurance for coverage. This leaves them with some tough decisions. Too often, one must choose between good health and finances. There’s no middle ground. The Medicare program was developed by the government to help those who are eligible with their overwhelming health care bills.
There is a lot of information to process when considering Medicare. Knowing what Medicare is and how it works will help you choose the program that will best meet your individual needs. But as complicated as all that sounds, there’s a single key choice at the core of all your decision-making. Will you go with the Original Medicare plan, which is run by the federal government and consists of Parts A and B, or a Medicare Advantage plan (also called Part C) that is offered by a private insurer and approved by Medicare?
What is Medicare?
Medicare is a government health insurance program administered by the Centers for Medicare & Medicaid Services (CMS). Medicare is the largest health insurance service in the country, with around 40 million Americans participating. To be eligible you must be a citizen of the United States and meet certain requirements. If you are not a citizen of the United States, you can contact the Social Security Administration office to learn if you would be eligible.
Can you answer yes to at least one of the following statements?
- I am 65 years of age or older.
- I am under 65, but I have certain disabilities.
- I have End-Stage Renal Disease (kidney failure that requires a transplant or dialysis).
If so, then you are likely to be eligible for Medicare benefits.
Medicare Part A
Part A is hospital insurance provided by Medicare. Most people do not pay a premium for this coverage. Part A covers inpatient care in skilled nursing facilities, critical access hospitals, and hospitals. Hospice and home health care are also covered by Part A.
Medicare Part B
Part B is medical insurance to pay for medically necessary services and supplies provided by Medicare. Most people will have to pay a premium to receive this coverage. Part B covers outpatient care, doctor’s services, physical or occupational therapists, and additional home health care.
Medicare Part C
Part C also known as Medicare Advantage is the combination of Part A and Part B. The main difference in Part C is that it is provided through private insurance companies approved by Medicare. With this program, you may have lower costs and receive extra benefits.
Medicare Part D
Part D is stand-alone prescription drug coverage insurance. Most people do have to pay a premium for this coverage. Plans vary and cover different drugs, but all medically necessary drugs are covered. You can choose what drug plan will be best suited to your needs.
Do you have questions about Medicare when moving out of state or to another county?
If you reside within the United States (including the District of Columbia, the U.S. Virgin Islands, Puerto Rico, Guam, and the Northern Mariana Islands), you may maintain your Original Medicare, Part A & B coverage. Of course, you’ll want to notify your health-care providers about your move to another state, and arrange for transfer of your medical records.
You might also have a stand-alone Medicare Part D Prescription Drug Plan, and/or a Medicare Supplement policy, working alongside your Original Medicare benefits. See below for information about how address changes may affect these plans.
- Medicare pays first for your health care bills
- Your group health plan coverage pays second
How your retiree group health plan coverage works depends on the terms of your specific plan. Your employer or union, or your spouse’s employer or union, might not offer any health coverage after you retire.
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I’ve worked in the insurance business for 18 years and I can honestly say that I have never met another insurance professional who is as passionate and as focused on customer service as Tim. The first ingredient in his work is integrity. If you are considering working with an insurance professional in any capacity I strongly suggest you contact Tim.
Tim Altman and Senior Choice Medicare Solutions (SCMS) have been offering senior products through JSA since 2012. In that time, SCMS has become one of our top-producing Managing General Agents with UnitedHealthCare in both Washington and Oregon. SCMS recruits, trains, and motivates quality agents through meetings, calls and e-mails, to offer health insurance options to Medicare-elgibles. In additions to execellent production, SCMS agents have proven to be doing business the right ways. JSA has had no report of complaints or other compliance issues from the carrier with which SCMS is doing business. We at JSA have full faith and confidence that Tim Altman and SCMS will continue to do an exceptional job for Washington and Oregon seniors in the future.
We’ve had the privilege to work with Senior’s Choice Medicare Solutions (SCMS) over the past two years. Their commitment to assisting those on Medicare through extensive education while being a neutral advocate is why we partnered with SCMS! The value to us is not needing specialized staff to educate clients on Medicare products. We simply refer them to a Medicare help line to get personalized services by a professional insurance representative. They provide outreach year-round, since many beneficiaries need assistance beyond the traditional open-enrollment period which runs from October 1 to December 7. SCMS created a personalized business plan for us designed specifically for our wants and needs. We continue to hear positive praise of the service they provide to our member and patients.