Upon turning 65, seniors have the ability to receive their healthcare through Medicare. While this is a great tool to use to receive the coverage you need, it can sometimes be complicated to understand the options and figure out what you need. That’s why we’re here – at Sunshine Senior Services, we’ve helped over 10,000 people enroll in Medicare benefits right here in the St. Louis area. Read below for more information about specific parts of Medicare.
Medicare Part A is part of traditional Medicare coverage that covers hospital stays and in-patient care, which means anytime you’re treated in a hospital or medical facility where you must be admitted. Additionally, Part A coverage includes the following:
Medicare Part B is the other part of traditional Medicare coverage that covers doctors’ visits and outpatient care. This means that any routine medical exam or visit is covered by this part of your plan. Part B includes access to:
When it comes to Medicare, it’s a convenient way for seniors to receive the medical care that they need. However, Medicare doesn’t always cover all the services they need. Many times, dental insurance, vision insurance and prescription drug coverage are excluded from Medicare plans. Luckily, we provide Medicare health program plans such as:
You can get your Medicare benefits through Original Medicare, or a MediAdvantage Plan (like an HMO or PPO). If you have Original Medicare, the government pays for Medicare benefits when you get them. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare. Medicare pays these companies to cover your Medicare benefits. If you join a Medicare Advantage Plan, the plan will provide all of your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage.
There are different types of Medicare Advantage Plans:
Who can join a Medicare Advantage Plan? You must have Medicare Parts A and B and live in the plan’s service area to be eligible to join. People with End-Stage Renal Disease (permanent kidney failure) generally can’t join a Medicare Advantage Plan.
Sometimes people ask, what do Medicare Advantage Plans cover? Medicare Advantage Plans must cover all of the services that Original Medicare covers except hospice care. Original Medicare covers hospice care even if you’re in a Medicare Advantage Plan. In all types of Medicare Advantage Plans, you’re always covered for emergency and urgent care. Medicare Advantage Plans must offer emergency coverage outside of the plan’s service area (but not outside the U.S.). Many Medicare Advantage Plans also offer extra benefits such as dental care, eyeglasses, or wellness programs. Most Medicare Advantage Plans include Medicare prescription drug coverage (Part D). In addition to your Part B premium, you usually pay one monthly premium for the plan’s medical and prescription drug coverage.
Plans are administered by various insurance companies, all offering benefits which meet minimum federal standards. Some plans have additional benefits beyond federal requirements. Plans can be reviewed and changed each year. Formularies, deductibles and an individual’s medication need can and do change.
Medicare Part D Plans cover, the types of drugs most commonly prescribed for Medicare beneficiaries as determined by federal standards. Each Part D plan has a formulary or list of drugs that are accepted by plan.
Here is a chart that may help you understand the “coverage gap” also referred to as the doughnut hole.