Medicare is the national healthcare system for people over the age of 65. Medicare insurance covers most medical services (both inpatient and outpatient), durable medical equipment, and medications.
There are various Medigap plans that allow Medicare beneficiaries to enroll in the most comprehensive coverage. Choosing a Medigap plan on your own can be frightening. With over 8 different lettered plans to choose from (Plans A –N) with different benefits (see below chart) we can navigate you through their differences to assist you in choosing the right plan for your budget.
Basics of Medigaps
Most Medigap plans cover the 20% that Medicare Parts A and B do not cover. Medigap plans are standardized by the government and are required to cover the same benefits as another carrier's plan.
Medigap plans have no network. You can get services from any doctor or facility that accepts Medicare. There are no networks or prior authorization required for services. They do not cover Medicare Part D so those plans can be purchased separately as well as any extra benefits such as vision and dental coverage.
Medicare Advantage - Medicare Part C (MA or MAPD)
These plans combine all the benefits of Medicare Parts A and B and can include Medicare Part D. (MA) plans are available to individuals entitled to Medicare Part A and enrolled in Medicare Part B due to age or disability.
This means they are available to people under age 65. You must live within the service area of the plan. They are offered by private insurance companies and offer low or zero premiums plans in addition to the Medicare Part B premium.
Medicare Advantage plans have copays or coinsurance for services as well as a maximum out of pocket (MOOP) for the plan year. Many also include vision, dental, hearing, gym discounts or memberships and OTC benefits.
Dual Eligible Special Needs Plan
Health plans for people who have both Medicare and Medicaid.
What’s the difference between Medicare and Medicaid? If you are not sure, we can help. We can also tell you if you qualify for Medicaid.
Medicare provides health insurance to individuals over 65, as well as individuals under 65 who qualify through disability. Medicare is a federal program, not a state program. Medicaid, however, is run by the state. Medicare is for the ageing population and disabled, whereas Medicaid is for individuals with low income. Each state has their own qualifications for Medicaid.