Medicare Insurance

Medicare Insurance explained! Discover how benefits, coverage & pricing work in our helpful, 2019 Medicare Insurance Guide.

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Basic Medicare Insurance covers;
Part A – Hospital Insurance
Part B – Medical Insurance
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Maybe you’ve heard some information about Medicare Insurance from friends & family but what exactly is Medicare Insurance anyway? How does health insurance fit within Medicare benefits? We consolidated & simplified all the important details for you by answering common questions to help save you time, money & energy!

Feel lost in the Medicare Maze? For senior folks who want to make a good health decision but feel confused about thier options or not knowing who to trust, Bridge has a plan to help you find the protection and peace of mind you need. Contact us or take “The Medicare Journey”, a clear path to understanding Medicare from “A Complete Health Plan Perspective”. Don’t let your health insurance end up costing you an arm and a leg!

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*For the purposes of this article, we will not be highlighting Medicaid. For more information on Medicaid and how to apply, visit the official Medicaid site.

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Last Updated: 10/2/2019

What is Medicare Insurance?

Medicare insurance is a federal, “pay-as-you-go” program, meaning; social security taxes today fund benefits today and any extra funds are held in a future account. Part of the tax pays for OASDI (old age, survivor and disability) benefits and the other fund goes to…you guessed it, Medicare! Medicare offers seniors two paths to choose from and we go more into depth on this subject in Medicare Redefined but for now these paths consist of Original Medicare (Part A and Part B) which covers approx. 80% of health insurance costs while the remaining 20% is covered under a Medicare Supplement Plan. The other path is Medicare Advantage (Part C) which works like an HMO Plan, but is 100% privatized insurance “backed by” Medicare. *NOTE: Recipients who choose to enroll in Advantage dis-enroll in Original Medicare and may NOT have an option to go back depending on health and eligibility factors (Read: Original Medicare vs. Medicare Advantage). To find answers for your unique situation, consult with a Bridge Agent today.

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What is the difference between Original Medicare and Medicare Advantage?

As mentioned above, seniors really only have two options to choose from in regard to health insurance and the differences go beyond just coverage, availability and price. Some would argue based on what side of economics you trust more. If you believe the U.S government should continue to manage and secure the health care you have been paying into your entire working life, then staying with Original Medicare might be your view (Keynesian view). However, if you believe it’s wise to dis-enroll in Original Medicare, and entrust your long term health care to the control of private corporations, Medicare Advantage might be your view (Classical view). At Bridge, we know some may not have the option to choose due to cost and price is an important factor when comparing health insurance. The private sector does influence both paths but the question remains; how much reliance will you entrust with your health care long term?

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What does Medicare Insurance cover?

Medicare Insurance may cover many things depending on what path one takes. The question you should really be asking is, “what does Medicare Insurance consist of?”. The answer: Medicare Insurance is made up of Four (4) Letter “Parts” NOT “Plans” which define your coverage options. *Note:When dealing with Medicare Insurance, there is big difference between the two terms; Parts and Plans because they represent entirely different things. By keep these terms separate in your mind, you will understand Medicare more easily! Additionally, how these parts work together is also a source of much confusion for people so for now, just glance them over and keep reading. As we continue on The Medicare Journey, this will all come together and make sense.

  1. Part A – Hospital Coverage (Gov’t Insurance).
  2. Part B – Physician Coverage (Gov’t Insurance).
  3. Part C – Medicare Advantage (Private Insurance).
  4. Part D – Prescription Drug Coverage (Private Insurance).

Additional coverage is available through Supplemental Plans;

  • Hospital Insurance (Part A).
  • Medical Insurance (Part B).
  • Medicare Part A Coinsurance.
  • Medicare Part B Coinsurance.
  • First Three (3) Pints of Blood.
  • Part A Hospice Coinsurance.
  • Skilled Nursing Facility Care Coinsurance.
  • Part A Deductible.
  • Part B Deductible.
  • Part B Excess Charges.
  • Part B co-payments
  • Foreign Travel Emergency Insurance.
  • Gym memberships and other perks.

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What does Medicare Insurance not cover?

Depending on the path one chooses, Medicare Insurance may not cover the following;

Always check your health plan carefully or have a licensed, Bridge Agent help find plans for you.

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How do I enroll in Medicare Insurance?

It’s easier than you think to enroll in Medicare Insurance because the availability is automatic upon turning age 65 after applying for Social Security benefits. If a recipient earned their full 40 credits, they are entitled to free, Medicare Part A. If they didn’t receive full credit, this coverage is paid for out of Social Security. We go over this topic on the first page of The Medicare Journey, titled, Social Security Benefits or go to The Complete Guide to Medicare Enrollment Periods.

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How do I compare Medicare Insurance?

When comparing private Medicare Insurance plans, it can be confusing and time consuming when vetting multiple carriers or paths. You can simplify the process by speaking with a Bridge Agent who can answer your questions and help you find results fast!

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2019 Medigap Guide

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Who pays for Medicare Insurance?

In short, most every employed or self-employed American pays for Medicare Insurance in the form of payroll taxes called the, Federal Insurance Contributions Act (FICA). FICA Infographic.

“It was a generation ago that Harry Truman said, and I quote him: “Millions of our citizens do not now have a full measure of opportunity to achieve and to enjoy good health….And the time has now arrived for action to help them attain that opportunity and to help them get that protection.” – Lyndon B. Johnson

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How is Medicare Insurance paid for?

Every three (3) months, those enrolled into Medicare, will receive a Medical Summary Notice (MSN), also known as an Explanation of Medicare Benefits (EOMB), which denotes all the specific medical costs and supplies billed to Medicare on behalf of the beneficiary from the previous quarter. Any excess charges (ie: the 20% GAP charges) are coordinated with private Medigap Insurance, Medicare Advantage or paid by the recipient.

If a recipient was under or over-charged, they can make a claim to the Medicare claims processor. In the case of Medicare claims, every enrollee has the right to appeal the following:

  • An application that was denied for a Medicare program.
  • If an enrollee received a service or line-item that is not covered by the plan and he or she believes it should be.
  • A service or item was denied and the enrollee believes it should be paid for.
  • The amount that Medicare actually paid for a service or item.
  • If Medicare or the enrollee’s plan provider (Carrier) stops providing or paying for all or part of a health care service, supply, item or prescription drug that the enrollee believes he or she still needs.

When appealing, an enrollee can self-file or appoint a representative to help with the process. A representative can be any of the following: family member, friend, attorney, doctor or anyone an enrollee chooses. After filing an appeal against a Medicare decision or expense, there are five levels of appeals an enrollee can go through (NIS, 2018);

  1. A redetermination by the company that manages claims for Medicare.
  2. A reconsideration from a Qualified Independent Contractor (QIC).
  3. A hearing before a Administrative Law Judge (ALJ).
  4. A review by Medicare Appeals Council (Appeals Council).
  5. A Judicial review by a federal district court.

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Who Manages Medicare Insurance?

Medicare eligibility and the processing of premiums go through the Social Security Administration (SSA) but Medicare laws and Medicare administration are NOT managed by the SSA. The Centers for Medicare and Medicaid Services (CMS) further administer the program by providing ‘enrollees’ with over 1.5 million healthcare providers and suppliers, that are contracted with the Federal Government.

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Do I need Medicare Insurance?

Although you are not forced to accept Medicare Insurance, it would be unwise to NOT accept it because Medicare is the foundation of all insurance. Don’t think your employer plan is all you need! Once enrolled, Medicare may become your secondary insurance but realize that its the foundation. You could be putting yourself in a compromising situation without basic coverage and forced to pay a penalty for choosing not to enroll on-time.

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In Conclusion

Medicare Insurance is a mix of both governmental and private health insurance for seniors (65yr+) who have two main paths to choose from 1) Original Medicare and 2) Medicare Advantage. Medicare Insurance consists of 4 Letter Parts NOT Plans that work together in a seemingly confusing fashion. Basic Medicare Insurance (Part A) is normally, freely given to Americans who have worked for at least 10 years and made (FICA) tax contributions. Medicare Insurance coverage varies depending on the path one takes with supplemental options available. Every one should enroll in Medicare because it is the foundation of all health insurance even if you have guaranteed employer health coverage as your primary insurance.

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Next Steps...

Medicare can be complex and confusing but we have good news! Bridge did all the research for you, so you don’t have to! If you just started following along with us, you can visit The Medicare Journey trailhead to see the roadmap, go the first chapter on Social Security, or jump to the Next Page!

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