Medicare Plans & Benefits

As Medicare evolves and adapts to meet the needs of seniors and individuals with disabilities, it grows in complexity and significance. Licensed insurance professionals have an integral role in understanding the basics of Medicare and its more detailed innerworkings. Medicare Plans and Benefits presents a comprehensive view of Medicare Basics, Parts A, B, C, and D, and how to choose a Medicare Supplement Policy. After completing this course, producers will be more equipped to serve vulnerable populations and provide extensive knowledge on Medicare’s various plans and offerings.

What is Medicare?

Medicare is a federally funded system of health and hospital insurance for U.S. citizens who:

  1. Are age 65 and older;
  2. Are younger than 65 receiving Social Security benefits for specific disabilities;
  3. Need dialysis or kidney transplants for treatment of end-stage renal disease (ESRD);
  4. Are diagnosed with Amyotrophic Lateral Sclerosis (ALS), commonly referred to as Lou Gehrig’s disease.
Dominic Javier is certified by the Center of Medicare and Medicaid Services

Parts A, B, C, and D Overview

Medicare consists of different parts that cover specific services. Medicare Part A is Hospital Insurance and helps cover inpatient care. It also covers hospice care, home health care services, and inpatient care in a skilled nursing facility—subject to limitations. Part A covers very limited custodial or long-term care.

Medicare Part B is Medical Insurance that primarily covers the costs of:

  1. Medically necessary services such as doctor’s services, outpatient care, durable medical equipment, and other medical services;
  2. Preventive or maintenance services intended to diagnose potential health problems before they become acute.

Medicare Parts A & B together are often referred to as Original Medicare.

Medicare Part C, or Medicare Advantage, offers plans through private insurance companies approved by Medicare. Part C plans must cover all Parts A and B services that Original Medicare covers, except hospice care, which is still covered under Original Medicare. In addition, Medicare Advantage Plans may offer extra coverage, such as vision or dental, and most include prescription drug coverage.

Medicare Part D is Prescription Drug Coverage. Prescription drug plans are offered through private insurance companies approved by Medicare. Part D covers much of the cost of prescription drugs within limits and places certain restrictions on prices.

The full retirement age for Social Security retirement benefits has been increased to age 67. Medicare eligibility begins at age 65.

Coordinating with Other Coverage

When duplicate coverage exists, the primary payer would first be responsible for medical bills up to the limit of the coverage the plan provides. The secondary payer might or might not cover any charges not covered by the primary plan, depending on that secondary’s contract provisions.

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