Medicare is a government-controlled health insurance program provided for the citizens of the United States of America who are sixty-five years of age & above, and for individuals under the age of sixty-five that are classified as disabled by the Social Security Association.
Medicare can be grouped into four parts:
– Part A (hospital insurance)
– Part B (medical insurance)
– Part C (also called Medicare Advantage plan, which is an alternative for original Medicare Part A and B)
– Part D (Prescription drugs coverage)
Medicare Part A (hospital insurance)
Medicare Part A is one of the parts of an original Medicare part that provides inpatient coverage in a mental unit, professional nursing facility, or hospital, should the need arise due to various medical conditions.
If you are one of the several citizens of the United States of America that have been paying their Medicare taxes or social security taxes, you are eligible for the coverage Medicare Part A offers without being obligated to pay premiums monthly or yearly, regularly. However, if you have not been paying your social security taxes for at least forty quarters during your stay in the United States of America, you will be required to pay a premium charge that may be about $471
Medicare Part B (medical insurance)
Medicare Part B is the other part of the original Medicare parts that provides coverage for outpatient preventive services and requisite medical treatments. The outpatient coverage includes visiting a healthcare specialist, therapeutic services, medical pieces of equipment, and supplies.
Medicare Part C
Medicare Part C, which is also called Medicare Advantage Plans, are alternatives for original Medicare—that is, Medicare Part A and Part B. They offer the combined coverage of both Medicare Part A and B with several other benefits, such as dental, vision, and hearing coverage.
Medicare Part D (Prescription drugs coverage)
Medicare Part D Is offers coverage for the expenses of prescription medications incurred by a policyholder with Medicare Part A and B policies (Original Medicare). It is usually common in government-funded health insurance, but private health insurance providers now offer Medicare Part D plan.
To benefit from this prescription medication coverage, the insured will be required to pay their premium, deductible, and coinsurance or copayment.
Coinsurance is the percentage of the total cost of treatment the insured would be expected to pay. It is usually twenty percent for Medicare Part B.
Copayment is the specific amount of money a policyholder would be required to pay when receiving treatment, and it primarily applies to prescription medications when it comes to Medicare.
Those that are eligible to receive benefits from the table of the Social Security Administration usually receive automatic enrollment in Medicare Part A and B. On the contrary, if you are not eligible for automatic registration, you will be required to apply for Medicare benefits three months before or three months after your sixty-fifth birthday. If you apply late, you will be required to pay penalties for Medicare coverage, which is usually a ten percent increase in your premium rate.
Health Maintenance Organizations
Preferred Provider Organizations
Health Maintenance Organizations (HMO)
Health Maintenance Organizations is one of the basic types of Medicare Advantage plans that offers the insured an in-network health services provider, such as doctors, hospitals, and specialists. Health Maintenance Organizations usually restrict the insured from using out-of-network health service providers. They must choose a primary care physician (PCP) who will coordinate their health care and give them referrals to visit specialists.
Preferred Provider Organizations (PPO)
Preferred Provider Organizations usually provide the insured with a network of contracted health care providers similar to larger Health Maintenance Organizations. Policyholders are not obligated but encouraged to get a primary care physician (PCP), and they do not require referrals before they can fix an appointment with any health care specialists. The freedom Preferred provider organization’s plans offer to the insured make them more expensive than Health Maintenance Organizations plans.
If you want to know the cost of purchasing specific types of Medicare Advantage plans, such as Health Maintenance Organizations or Preferred Providers Organizations, you will have to go through the following process:
1. Search for Medicare.gov’s plan finder tools online
2. Enter your zip code
3. Answer the questions that will be provided on your screen
4. Click on search
You will see the type of Medicare Advantage plans that is/are offered in your area, and their estimated cost after you click on search. The results are rated from one to five, depending on a few factors, such as provider choice, price, and customer satisfaction. The results are always authentic because they come from the government agency that supervises or guide Medicare Advantage Plans, which is the Center Of Medicare and Medicaid Services (CMS).
The Center of Medicare and Medicaid Services (CMS) is a body that supervises or guide the Medicare Advantage plans by setting guidelines and regulating the pricing, health insurance providers, and marketing practices offered by Medicare Advantage Plans. The Center of Medicare and Medicaid Services has the power to fine, suspend and terminate the plans of an insurance provider that violates their set aside rules. The policyholder can file a claim should their rights be violated by any insurance provider using the Claim and Appeal tab on the Medicare.gov site.
The Medicare.gov site used for filing claims and comparing plans is also used to sign up for a Medicare Advantage plan. You can also contact an individual insurance provider and talk to a licensed customer care representative to provide you with the necessary information you will need before walking you through the enrollment process.
There are various options of Medicare Part C insurance providers in the competitive market, which differ in costs due to the difference in the factors they consider determining the premium rate a policyholder is expected to pay. These factors may include age, location, income, and health status. Since they all have different premium formulas, it is advisable to compare and contrast many quotes from different insurance companies (at least three) to be more secure.
Studies and research have shown that the best Medicare Plan C insurance provider include Humana, Aetna, BlueCross BlueShield, and Highmark.