Friday, February 20, 2015

Advantage Medicare


It is no secret that the cost of healthcare in the United States, is very high and people who are at a disadvantage like the elderly, the disabled, the poor, those without a steady job find it particularly hard to pay for hospitalization, medication, and any form of treatment. Privately subscribed Health Insurance Plans are not a solution for everybody, as primarily many people in the above categories would not be eligible for the plans. Secondly, all private insurance plans are customized to the individual person’s risk profile, who is under the plan.

On the contrary. Medicare is a Federal Government instituted Social Insurance program. Being a social program, it guarantees certain benefits to every single citizen of the country and is funded by taxes paid as well as Federal grants.

Benefits of Medicare

Medicare has four parts to it:
  1. Part A: Hospital/Hospice insurance
  2. Part B: Medical insurance
  3. Part C: Medicare Advantage plans
  4. Part D: Prescription drug plans
Part A: Hospital/Hospice insurance
  • Inpatient hospital care
  • Skilled nursing facility care
  • Home health care
  • Hospice care
  • Blood (under certain conditions)
Part B: Medical insurance

This pays for a whole lot of services and procedures that are not covered by Part A as long as they are regarded as outpatient treatments. Working professionals who have a group health insurance at the workplace can defer the Part B plan for themselves and their dependents. The services covered include all services that require specialists like physicians, nurses or lab technicians. This includes diagnostic services like Blood tests and X-rays, all laboratory and diagnostic procedures, vaccinations, dialysis, blood transfusion, chemotherapy, organ transplant, hormone replacements, ambulance service etc. Additionally, medical equipment (DME) required by the patient is also provided under Part B. This includes walkers, wheelchairs, artificial limbs, special eyeglasses, canes, collars, etc.

Part C: Medicare Advantage plans

Medicare Advantage health plan evolved in line with better affordability for the financially well endowed. Such members pay an additional monthly premium, over and above the premium paid for Part A and Part B. This includes certain prescription drugs, dental care, eye care, periodic checkups, coverage while traveling outside the United States, health club memberships, health camps, gym and spa treatments etc (under certain conditions). However, a much larger benefit is that it reduces the 20% co-pay condition, and the high deductible charges associated with the Original Medicare.

Part D: Prescription drug plans

Although these plans are part of the Medicare program, they are administered by private health insurers. This means, there is no standardization here and the private insurer can choose the class of drugs and level of drugs to cover.

Part A and Part B are plans were designed several years ago and these plans offer a fee-for-service kind of coverage, and are often called the Original Medicare plans. People who have only subscribed for Part A and Part B, can take additional coverage such as Medigap or go in for a private Medicare Advantage plan offered by a Medicare HMO.

This includes Part A also covers rehabilitation or convalescence in skilled nursing facilities, as long as it is for short durations and under certain conditions. For terminally-ill patients who have 6 or fewer months to live, hospice benefits are extended under Part A under certain conditions and based on the recommendation of the physician.

Medicare provides tremendous benefits in standardizing cost, coverage, access and information about the plans. However, to ensure that you are on the right plan and are adequately covered, it would be wise to talk to experienced brokers / advisors available at the insurance companies before finalizing on a healthcare insurance plan for you or your family. Allied Brokers, a renowned and decades old insurance company, located in the Bay Area, can help you to understand and subscribe to the right Medicare plans and coverage.

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