Medicare, Medicare Advantage and Medigap demystified

Those who are eager to take up Medicare need to understand several terminologies involved and benefits with it. Plans, Parts, deductibles, coinsurance, copays, Medicare Supplement plans, MAPD, POS, HMO, PPO are some language that can be really confusing for anyone. To understand the choices and benefits available, the person need to become a Medicare expert.

Medicare and its four parts

The very first step involves understanding of few Medicare basics. There are four parts, where every part has been designated by A-D letter.

  • Part A covers board, room and other expenses in inpatient situation and can include skilled nursing facility, hospital and hospice care. There are coinsurances and deductible to be paid by the policy holder. Premium is not required.
  • Part B is Medicare’s outpatient side and includes surgical services, doctor visits, speech therapy, physical therapy, home healthcare, durable medical equipment, certain drugs and outpatient testing. 80% of all approved amounts of such expenses are covered by Part B after the person has met annual deductible. Monthly premium will have to be paid and enrolment is optional. If there is delay in enrollment, then late enrollment penalty is included to premium, unless there is other creditable coverage.

  • Part C is called Medicare Advantage. It is optional and requires additional premium. The plans should cover what is covered by Parts A & B. Few Advantage plans also include benefits not included in original Medicare such as eye glasses, dental coverage, gym membership and prescription coverage. POS, PFFS, PPO and HMO are several Advantage plans present. Advantage plan coverage is similar to that of Parts A & B. However, it is not similar as Parts A & B with Medicare Supplement plans. There are to be met copays, coinsurance, etc for office visits and hospital stays. Medicare Supplement plans cannot be added to Advantage plans for cost coverage.
  • Part D is prescription coverage, which is Medicare mandated and approved. Monthly premium is to be paid. Late enrollment will mean having to pay late enrollment penalty at the time of actual enrolment. Fine will be determined upon number of months that the person is eligible to avail Part D and month enrolled.

Therefore, it will be useful to take out some time to research and find out what each Medicare part and Medicare Supplement plans has to offer. Also would be necessary to know where the person is vulnerable with the availed coverage. this will help to select the best plan that will make the person to enjoy life and lead good health and av medical treatments, whenever required.