Business Benefits Group helps individuals approaching retirement age understand and select the Medicare option that is right for them, including supplemental insurance. BBG’s Benefits Consultants can assist older Americans in picking the best coverage for their situation.
Medicare: An Overview
While the Medicare system has been greatly simplified in recent years, it can still be a complicated process to navigate, with different types of insurance, coverage gaps, and additional considerations.
Eligibility for Medicare
The Medicare program has been in existence since 1965, when almost half of Americans over age 65 did not have health insurance and could not afford medical care. Now, the Medicare program provides health insurance for over 45 million Americans, including 38 million seniors and 7 million younger people with certain disabilities. Employees who have contributed to Medicare through payroll taxes are generally eligible for Medicare at age 65—regardless of income or health. Employees who are under age 65 may be eligible for Medicare if they have received Social Security Disability Insurance for more than two years, or if they have permanent kidney failure or Lou Gehrig’s disease.
Different Types of Medicare
Medicare has four separate programs, known as “parts” that provide coverage for different services. When an individual turns 65, they can automatically enrolled in Medicare Part A, should they qualify. This is the hospital insurance program, which helps to cover the cost of inpatient care in hospitals and skilled nursing facilities, hospice services and some home health care services. For most Americans who contributed to Medicare through taxes, there is no premium for Part A. However, if an individual did not work or contribute enough to Medicare while working, then he/she may not be eligible for premium-free Part A. In that situation, the individual may be able to purchase Part A for a monthly premium.
Medicare Part B
Part B is known as the medical insurance program. It helps to pay for some of the services not covered by Part A, including outpatient medical care, doctors’ services, preventative care, and physical and occupational therapy. Anyone enrolled in Part B will be required to pay a monthly premium, which can be deducted from a social security check. This premium is based in part upon income level.
Medicare Part C
Medicare Part C, the Medicare Advantage program, permits enrollees to choose an insurance plan offered by a private insurance company that has been approved by Medicare. This includes managed care and private fee for service plans. These plans are paid in part by Medicare, to cover the portion of the premium attributed to Part A and Part B. The plans often include prescription drug coverage (Part D) and may offer additional options, such as dental, vision and hearing care, and health and wellness programs. They typically require payment of an additional premium and copayments for certain services.
Medicare Part D
Part D provides outpatient prescription drug coverage to all individuals eligible for Medicare. To enroll in Part D coverage, an individual must subscribe to a plan run by a private insurance company, including Medicare Advantage plans. Part D prescription plans vary by state. Each plan has to provide a minimum level of prescription drug benefits.Many plans offer additional benefits, such as low copayments and annual deductibles and coverage for the “donut hole”—a temporary limit on prescription drug coverage. It can be difficult to choose the Part D plan that is the best option, given the different benefits, the donut hole, and levels of coverage offered. By 2020, the donut hole will be effectively closed, making Medicare recipients responsible for only 25% of the costs instead of 100%.
What Does Medicare Pay For?
Medicare will only cover those services that are deemed “medically necessary.” This means that the services must be needed to diagnose or treat a medical condition, and that the meet the general standards of medical care in a community. Medicare will not cover those services that are provided mainly for convenience, or the convenience of an attending physician. If an individual is concerned about the level of coverage that Medicare will provide, they may want to consider additional options such as purchasing supplemental insurance. Importantly, supplemental insurance can only be used in combination with original Medicare (Parts A and B), and not a Medicare Advantage plan.
Advantages of Working with BBG’s Benefits Consultants
Determining Medicare coverage is a multi-step process that requires understanding the various levels of coverage available, the copayments, premiums and deductibles. BBG’s Benefits Consultants can help to determine how to best utilize coverage (through original Medicare or a Medicare Advantage plan), whether need drug coverage is required, and if there is a need to add supplemental insurance coverage. By working BBG, clients can take advantage the expertise of our Benefits Consultants when selecting these plans. This can help to alleviate stress and confusion, while also ensuring that coverage is being leveraged properly.
Contact BBG For More Information Today!
For assistance with Medicare—contact Business Benefits Group by sending us a message online or giving us a call today. We offer complimentary consultations so that clients can make a well-informed decision.