Medicare Part A
Medicare Supplement, or Medigap, plans fill in the gaps in coverage left behind by Original Medicare, such as deductibles, coinsurance, and copayments. Golden Financial Group offers medicare supplement plans through various health insurance carriers. There are a variety of (standardized) plan designs with each carrier ranging from plan A through plan N.
Medicare Supplements will usually have less cost sharing but as a result they will generally have higher premium than a Medicare Advantage Plan but will have much less cost sharing when receiving medical services. Medicare supplements are readily accepted by doctors and hospitals that accept Medicare in any state.
If you are looking for a Medicare supplement plan or you are frustrated with the constant rate increases from your current Medicare supplement provider call Golden Financial Group today for a comparison quote. Begin saving on health insurance premiums like hundreds of our clients already have!
Originating in the 1960s, Medicare is a government-provided fee-for-service insurance program intended primarily for seniors. The program encompasses several distinct parts, each of which is outlined below.
Medicare Part A covers facility-based care such as hospital visits, emergency room services, hospice, and nursing home care.
Medicare Part B covers traditional outpatient treatments and services, including vaccinations, lab tests, mental health services, outpatient operations, durable medical equipment, and most other medical services not performed in a hospital.
Medicare Part C (Medicare Advantage) covers elements of Parts A, B, and sometimes D.
Medicare Part D covers prescription drugs.
Medigap comes through private insurance companies and aims to fill in the “gaps” left in the traditional Medicare coverage.
Know Your Choices
While standard Medicare offers coverage for a wide variety of services, you may find that a different plan through a separate insurance carrier better fits your needs. If you are interested in an alternative plans, we can help you find coverage through either Medigap or Medicare Advantage. Both of these plans offer additional support through third-party insurers, and they are required to provide equal or better coverage when compared to regular Medicare.
Medicare Part B (Medical)
Part B medical insurance helps pay for some services and products not covered by Part A, generally on an outpatient basis. Part B is optional and may be deferred if the beneficiary or their spouse is still actively working. There is a lifetime penalty (10% per year) imposed for not taking Part B if not actively working.
Part B coverage includes physician and nursing services, x-rays, laboratory and diagnostic tests, influenza and pneumonia vaccinations, blood transfusions, renal dialysis, outpatient hospital procedures, limited ambulance transportation, Immunosuppressive drugs for organ transplant recipients, chemotherapy, hormonal treatments such as lupron, and other outpatient medical treatments administered in a doctor’s office. Medication administration is covered under Part B only if it is administered by the physician during an office visit.
Part B also helps with durable medical equipment (DME), including canes, walkers, wheelchairs, and mobility scooters for those with mobility impairments. Prosthetic devices such as artificial limbs and breast prosthesis following mastectomy, as well as one pair of eyeglasses following cataract surgery, and oxygen for home use is also covered.
As with all Medicare benefits, Part B coverage is subject to medical necessity. Complex rules are used to manage the benefit, and advisories are periodically issued which describe coverage criteria. On the national level these advisories are issued by CMS, and are known as National Coverage Determinations (NCD). Local Coverage Determinations (LCD) only apply within the multi-state area managed by a specific regional Medicare Part B contractor, and Local Medical Review Policies (LMRP) were superseded by LCDs in 2003.
Medicare Supplement Insurance (Medigap)
A Medigap policy is health insurance sold by private insurance companies to fill the “gaps” in Original Medicare Plan coverage. Medigap policies help pay some of the health care costs that the Original Medicare Plan doesn’t cover. If you are in the Original Medicare Plan and have a Medigap policy, then Medicare and your Medigap policy will pay both their shares of covered health care costs.
Insurance companies can only sell you a “standardized” Medigap policy. These Medigap policies must all have specific benefits so you can compare them easily.
You may be able to choose up to 12 different standardized Medigap policies (Medigap Plans A through L). Medigap policies must follow Federal and State laws. These laws protect you. A Medigap policy must be clearly identified on the cover as “Medicare Supplement Insurance.” &Each plan, A through L, has a different set of basic and extra benefits.
It’s important to compare Medigap policies because costs can vary. The benefits in any Medigap Plan A through L are the same for any insurance company. Each insurance company decides which Medigap policies it wants to sell.
Generally, when you buy a Medigap policy you must have Medicare Part A and Part B. You will have to pay the monthly Medicare Part B premium. In addition, you will have to pay a premium to the Medigap insurance company.
You and your spouse must each buy separate Medigap policies. Your Medigap policy won’t cover any health care costs for your spouse.
Medicare Advantage Plans (also known as Medicare Part C) are health plan options that are part of the Medicare program. If you join one of these plans, you generally get all your Medicare-covered health care through that plan.
This coverage can include Medicare Part D prescription drug coverage or you can enroll in a separate Medicare Part D prescription drug coverage plan. Medicare Advantage Plans include:
Medicare Health Maintenance Organization (HMOs)
Preferred Provider Organizations (PPO)
Private Fee-for-Service (PFFS) Plans
Medicare Special Needs Plans (SNP)
Medicare Medical Savings Accounts (MSA)
Medicare Advantage Plans