What is Medicare?

Medicare is a federal health insurance program that was enacted in 1965 with President Johnson enrolling President Truman as the first Medicare beneficiary and giving him his first Medicare card. This program was expanded in 1972 to cover certain people under 65 who have a long-term disability. Today, Medicare plays a key role in providing health and financial security to over 60 million people and younger people with disabilities. This program helps pay for many medical services, including hospitalizations, physician visits, prescription drug, preventive services, skilled nursing care, home health care, and hospice care.

Did you know Medicare Supplement plans have been around since 1992?

Typically, these plans start with a letter (A – N) and some have been eliminated over the years. Today, these are the plans available.

• • Plan A (Not to be confused with Medicare Part A)
  • Plan B (Not to be confused with Medicare Part B)
  • Plan D (Not to be confused with Part D)
  • Plan G
  • Plan K
  • Plan L
  • Plan M
  • Plan N
  • Plan C (No longer available for people that turned 65 after January 1st, 2020)
  • Plan F (No longer available for people that turned 65 after January 1st, 2020)

NOTE: You may still qualify for Plan C or Plan F if you already have a Medicare supplement plan in place. Certain rules apply and varies by state.

Medigap is Medicare Supplement Insurance that helps fill “gaps” in Original Medicare and is sold by private companies. Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. A Medicare Supplement Insurance (Medigap) policy can help pay some of the remaining health care costs, like:

• • Copayments
  • Coinsurance
  • Deductibles

Some Medigap policies also cover services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, here’s what happens:

• • Medicare will pay its share of the Medicare-approved amount for covered health care costs.
  • Then, your Medigap policy pays its share.

Medigap policies generally don’t cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.

In 2003, Medicare Prescription Drug (Part D) and the Improvement and Modernization Act (MMA) came about.

The MMA’s most touted feature was to introduce the entitlement benefit for prescription drugs through tax break and subsidies. As new and expensive drugs have come into use, patients, particularly senior citizens at home Medicare was targeted, have found prescriptions harder to afford. The (MMA) was designed to address this problem.

The Benefit is funded in a complex way, reflecting diverse priorities of lobbyists and constituencies.

• • It provides a subsidy for large employers to discourage them from eliminating private prescription coverage to retired workers (a key AARP goal);
  • It prohibits the federal government from negotiating discounts with drug companies;
  • It prevents the government from establishing a formulary, but does not prevent providers such as HMOs from doing so.

In 2005, Medicare Advantage plans (Part C) came into play.

Medicare Advantage Plans are another way to get your Medicare Part A and Part B coverage. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by Medicare-approved private companies that must follow rules set by Medicare. Most Medicare Advantage Plans include drug coverage (Part D). In many cases, you’ll need to use health care providers who participate in the plan’s network and service area for the lowest costs. These plans set a limit on what you’ll have to pay out-of-pocket each year for covered services, to help protect you from unexpected costs. Some plans offer out-of-network coverage, but sometimes at a higher cost. Remember, you must use the card from your Medicare Advantage Plan to get your Medicare-covered services. Keep your red, white, and blue Medicare card in a safe place because you’ll need it if you ever switch back to Original Medicare.

In general there are 4 main types of Medicare Advantage plans and 2 other less common types that may be available.

• • Health Maintenance Organization (HMO)
  • Preferred Provider Organization (PPO)
  • Private Fee-for-Service (PFFS)
  • Special Needs Plans (SNPs)
  • HMO Point of Service (HMO-POS)
  • Medicare Medical Savings Account (MSA)

Click here to learn more about Medicare Advantage Plans.

In 2006, Medicare Part D Plans (Part D) came about.

Medicare drug coverage helps pay for prescription drugs you need. Even if you don’t take prescription drugs now, you should consider getting Medicare drug coverage. Medicare drug coverage is optional and is offered to everyone with Medicare. If you decide not to get it when you’re first eligible, and you don’t have other creditable prescription drug coverage (like drug coverage from an employer or union) or get Extra Help, you’ll likely pay a late enrollment penalty if you join a plan later. Generally, you’ll pay this penalty for as long as you have Medicare drug coverage. To get Medicare drug coverage, you must join a Medicare-approved plan that offers drug coverage. Each plan can vary in cost and specific drugs covered.

There are 2 ways to get Medicare drug coverage:

1. 1. Medicare drug plans. These plans add drug coverage to Original Medicare, some Medicare Cost Plans, some Private Fee‑for‑Service plans, and Medical Savings Account plans. You must have Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) to join a separate Medicare drug plan.
   2. Medicare Advantage Plan (Part C) or other Medicare health plan with drug coverage. You get all of your Part A, Part B, and drug coverage, through these plans. Remember, you must have Part A and Part B to join a Medicare Advantage Plan, and not all of these plans offer drug coverage

Email us to get specific Medicare drug plan and Medicare Advantage Plan Costs, you can also call us today to get more details.

Click here to learn more about Prescription Drug Plans.

In 2010, The Patient Protection and Affordable Care Act(PPACA) came into the mix.

The first part of the comprehensive health care reform law enacted on March 23, 2010.

The law was amended by the Health Care and Education Reconciliation Act on March 30, 2010. The name “Affordable Care Act” is usually used to refer to the final, amended version of the law. (It’s sometimes known as “PPACA,” “ACA,” or “Obamacare.”)

The law provides numerous rights and protections that make health coverage more fair and easy to understand, along with subsidies (through “premium tax credits” and “cost-sharing reductions”) to make it more affordable.

The law also expands the Medicaid program to cover more people with low incomes.

Most people ages 65 and over are entitled to Medicare Part A if they or their spouse have worked in the United States for at least 40 quarters. Additionally, people under 65 who receive Social Security Disability Insurance (SSDI) generally become Medicare eligible after a two-year waiting period. Those diagnosed with end-stage renal disease (ESRD) and amyotrophic lateral sclerosis (ALS) become eligible for Medicare with no waiting period.

If you wish to learn more about Medicare and how Medicare would work with private or public insurance please give us a call today (425) 221-9485. Or you can fill out our quick contact form here.