Medicare Advantage – Pre Authorization
June 4, 2023 No Comments
The Medicare Advantage program, also known as Medicare Part C, has become one of the major Medicare plans in the American healthcare system since its
Parts of Medicare
Medicare is a bit challenging to take in. It can be easy to get confused and even frustrated with the program with all the parts involved.
Even with an agent at hand, It can be challenging to get a reasonable explanation that is simple to understand. This can make it harder for you can make the best choice for your health. Medicare as a plan has evolved over the past few decades. Because of that, it is even more confusing as it is now divided into four different parts.
Why are there so many parts of Medicare? What does each part of Medicare cover? Do I have to have each part of Medicare? If you’re confused by these questions, you’re not alone!
We are going to take a dive into the 4 different Parts of Medicare. Each part of Medicare will be broken down so you’ll have a much deeper and better understanding of what each part does and how it relates to you and your ongoing healthcare needs.
Health insurance should be easy to understand when we are in our retirement years! The first step to simplifying this maze, is getting all of our pieces (or parts) in order and defined.
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The Four Parts of Medicare
- Part A is Inpatient Hospital Coverage
- Part B is Medical Insurance
- Part C is the Medicare Advantage Plans
Part D is Your Prescription Plans.
Though this list is relatively basic, it’ll give you a basic idea of what each does. Below, you get an in-depth look that’ll explain each part to increase your understanding and dispel any questions or confusion you may have.
If this wasn’t confusing enough, there are also some parts that don’t fall under a letter! Medicare Supplement Plans, also known as MediGap plans, can take over for your Part C coverage, rather than enrolling in a Medicare Advantage plan.
Medicare Part A
Medicare Every state and insurer is required to offer MediGap plan A (sometimes under a different name). It is important to remember that this is Plan A NOT Part A is your hospital insurance. This part of Medicare will help you cover your monthly ordinary inpatient hospital expenses.
This can include things such as the cost of a semi-private room for your stay at the hospital. It even covers hospice care, some of your home healthcare, and even a Skilled Nursing Facility stay in the case that has something you need. Part A of Medicare will also cover any blood transfusions that require more than 3 pints of blood.
Many people assume that Medicare is free. Medicare Part A is the closest part of “free Medicare.” Anyone 65 years or older, who has worked at least ten years (40 quarters) in the United States, qualifies for premium-free Part A. The reason you do not have a premium for Medicare Part is because you have been paying into it your entire working life. So, although it seems free now, it was more of an investment through your taxes. You will also qualify for premium-free Medicare part A if you have been married to someone at least 62 years-old who has worked the 40 quarters.
If you did not work the 40 quarters to qualify for premium-free Medicare Part A, you can still enroll at age 65, but you will have to pay a monthly premium for this coverage. The premium for Part A is based on the amount of quarters you worked. In 2024, if you worked between 30-39 quarters your monthly premium for Medicare Part A is $278 per month, and if you worked less than 30 quarters, it is $506 per month.
Give us a call at 877-88KEITH (53484), an experienced agent will walk you through how to determine your Medicare Part A premium
Now that we know the cost, what does Medicare Part A cover?
When it comes to thinking about part A of Medicare, you look at it as your room and board while you’re in the hospital. This is going to be your inpatient care during your stay.
Also, this part of Medicare will provide you with a semi-private room for your hospital stay. It also includes your meals and medical services that you may need while you’re in the hospital.
You may be wondering if you only need Part A or if you need another part. You may also be healthy enough where you may not need this many medical services. It may have crossed your mind on whether you can get away with Medicare part A by itself. You are not alone in this thinking. Some things could happen while you’re in the hospital that will fall under another part of Medicare. You may not want to think that you may need other services or believe that you are covered enough under Medicare part A. The reality is that it’s crucial for you to also enroll in Medicare Part B. This is especially important if you do not have any other coverage outside of Medicare. This could be health insurance that is part of your retirement plan or additional private insurance. However, it’s best to make sure you are enrolled in Medicare A and Medicare Part B if Medicare is your primary health insurance.
You can contact Social Security to find the status of your Medicare Part A and your Medicare Part B.
Medicare Part B
Medicare Part B is for all your outpatient services that have been deemed medically necessary or preventative by your doctor or physician.
Much of Medicare’s Centers for Medicare and Medicaid Services. Also known as CMS.
Both Medicare Part A and Part B coverage includes services like doctor’s office visits, diagnostic imaging, preventive care, lab testing, surgeries, and even ambulance rides. It will also help cover chemotherapy, radiation therapies, and even any extensive dialysis care for those with renal failure.
Unfortunately, these procedures may occur while you were in the hospital. However, even though Medicare Part A covers your inpatient stay, it will be Part B of Medicare that covers all these procedures you may need while in the hospital. This is because the physicians that provide these services are going to be the ones that determine whether or not these services will be inpatient or outpatient care. This is why it’s essential to fully understand what Part A and Part B of Medicare covers.
There are many times when you may ask if you need Part B of Medicare. In all honesty, the answer is yes. This is especially true if Medicare will be either you’re only coverage or your primary coverage when it comes to your healthcare.
Even though these are two different parts of Medicare, Parts A and B are commonly called Original Medicare. These were the first two parts included in Medicare that became law over 40 years ago.
You are only able to sign-up through Medicare Part A and Part B through the Social Security office.
What about the cost? Is Medicare Part B free like Medicare Part A?
Unfortunately, unlike Medicare Part A, Medicare Part B does come with a monthly premium. The standard premium for Medicare Part B in 2024 is $174.70 monthly. This is standard premium is the average for most Americans across the country, although the monthly premium can actually increase based on the tax bracket you fall into according to your most recent tax return. This increase in the Part B premium is known as the Income Related Monthly Adjustment Amount (IRMAA).
When it comes to Medicare and your health, it is essential to make sure that you’re enrolled in Parts A and B. With both of these together, a lot of your inpatient and outpatient care is going to be covered. Even if you are a healthy individual, something may happen that will require you to need both. Therefore, its better to be safe than sorry with your health care. Medical bills can add up relatively quickly, and they are quite costly. When you’re at the Social Security office signing up for Medicare, make sure you’re enrolled for both. That way, you are protected in the event of an emergency or for any of your everyday healthcare needs.
Give us a call at 877-88KEITH (53484), an experienced agent will walk you through how to determine your Part B premium.
How To Enroll in Medicare
When you are turning 65, enrolling in Medicare Part A and Medicare Part B is very simple. In fact, you can complete your Medicare enrollment totally online without having to step into a Social Security office! You can apply for both Medicare Parts A and B.
How to Enroll in Medicare Part A
Medicare Part A is your hospital coverage. For most people, Medicare Part A has a $0 monthly premium, so many choose to enroll in Part A even if they plan to continue working and remain on their employer’s insurance. You can apply for Medicare Part A online through the Social Security website.
Our easy to remember forwarding link for the application: www.StartPartB.com
How to Enroll in Medicare Part A
Medicare Part A is your hospital coverage. For most people, Medicare Part A has a $0 monthly premium, so many choose to enroll in Part A even if they plan to continue working and remain on their employer’s insurance. You can apply for Medicare Part A online through the Social Security website.
Our easy to remember forwarding link for the application: www.StartPartB.com
How to Enroll in Medicare Part B
Medicare Part B is your outpatient coverage. Unlike Medicare Part A, there is a premium for Medicare Part B. The standard premium in 2024 is $174.70, therefore you will only want to enroll in Medicare Part B if Medicare will be your primary health insurance. You can also enroll in Medicare Part B through the Social Security website. In order to apply for Medicare Part B through the main link, you must be in your Initial Enrollment Period. If you are past age 65 and qualify for a Special Enrollment Period, there is a different process for applying for Medicare Part B, as you need additional information such as the employer coverage form CMS L-564.
Our easy to remember forwarding link for the application: www.StartPartB.com
Medicare Part C
Medicare Part C can be somewhat of a confusing part of Medicare to understand.
Unlike the other parts of Medicare that cover specific medical benefits and aspects of your health care, Part C of Medicare is just another name for private Medicare insurance. In 1997 the Balanced Budget Act created Medicare Part C. Nowadays, this is referred to as Medicare Advantage.
Medicare Advantage plans are monthly private health plans. You can choose one of these over Original Medicare. Although with a Medicare Advantage plan, you must remain enrolled in Medicare Part A and Medicare Part B, as well as pay the associated premiums.
The healthcare you would get from Part A and B, and sometimes Part D of Medicare, can be found within one insurance carrier through Medicare Advantage. Usually, the Advantage Plans will have network providers for whom you will seek your care. Some will allow you to continue with the current provider you’re currently using. However, it is best to look at what each plan has for coverage to see which one will fit your needs.
Most Part C plans will usually have a lower premium than most Medigap plans, however, that doesn’t make them “less expensive.” Medicare Advantage plans are typically pay-as-you-go plans, meaning you are likely to have co-pays, deductibles, and out-of-pocket maximums on these plans. These plans aren’t necessarily cheaper in the long term. This can mean the longer and more often you use the plan, the higher your bills will accumulate. The highest an out-of-pocket maximum on a Medicare Advantage plan can be in 2024 is $8,850 per year.
Before you enroll in Part C of Medicare, it is crucial to understand the differences between Medicare Advantage plans and Medicare Supplement plans. You need to understand the differences in coverage before making a decision, as each plan has significant differences.
I don't generally recommend Medicare Advantage plans do to the higher out of pocket costs and the limited choice of doctors and hospitals. I prefer to be able to choose any doctor or hospital that accepts Medicare.
Keith Armbrecht
Medicare on Video
Medicare Part D
We are almost there, Part 4 of 4! Just hang on a bit longer! Medicare Part D is a federal program created to lower your retail prescription drug cost.
As you may have already realized, prescription drugs can be quite expensive. This cost can be even higher if you are taking a brand name drug, rather than a generic. Medicare Part D will help alleviate a lot of the costs that are associated with your prescription drugs. This will make them a lot more affordable and, in some cases, may cover the full expense of the drug that you need. Unlike Part A and B of Medicare, you will not have to spend time at the Social Security office to enroll in Part D of Medicare.
The only thing you will need to do is select the Part D plan available in your county from a private insurance carrier. By signing up for a specific plan, you will have enrolled in part D of Medicare. Although you can sign-up for a Medicare Part D plan on your own, it is important to speak with a licensed agent who can walk you through all of the aspects, including premiums, deductibles, and coinsurance levels. Medicare Part D plans carry a monthly premium, although these premium amounts are not fixed like Medicare Part A and Part B. Medicare Part D premiums differ based on your location, as well as your list of current prescriptions. The amount of coinsurance you will pay for your prescriptions will also differ based on the tier level of your medication. Typically the lower the tier level, the lower your cost for the drug. Medicare Part D enrollment is optional. That is great news if you don’t take any prescriptions, right? Not necessarily. Unfortunately even if you do not take any prescriptions when you complete your Medicare enrollment and decide not to enroll in a Part D plan, you are going to face a late enrollment penalty in the future if you do decide to ever enroll. This penalty is 1% per month you delay your enrollment multiplied by the base modal premium, which is subject to change each year. Unfortunately, there are rules on when you can enroll or disenroll from any Part D drug plans. You can visit the Medicare Part D section that is on this website. Here, you can get more details about how your drug coverage under Medicare will work for you and your ongoing healthcare needs. Give us a call at 877-88KEITH (53484), an experienced agent will review your Medicare Part D options.
As you may have already realized, prescription drugs can be quite expensive. This cost can be even higher if you are taking a brand name drug, rather than a generic. Medicare Part D will help alleviate a lot of the costs that are associated with your prescription drugs. This will make them a lot more affordable and, in some cases, may cover the full expense of the drug that you need. Unlike Part A and B of Medicare, you will not have to spend time at the Social Security office to enroll in Part D of Medicare. The only thing you will need to do is select the Part D plan available in your county from a private insurance carrier. By signing up for a specific plan, you will have enrolled in part D of Medicare. Although you can sign-up for a Medicare Part D plan on your own, it is important to speak with a licensed agent who can walk you through all of the aspects, including premiums, deductibles, and coinsurance levels. Medicare Part D plans carry a monthly premium, although these premium amounts are not fixed like Medicare Part A and Part B. Medicare Part D premiums differ based on your location, as well as your list of current prescriptions. The amount of coinsurance you will pay for your prescriptions will also differ based on the tier level of your medication. Typically the lower the tier level, the lower your cost for the drug. Medicare Part D enrollment is optional. That is great news if you don’t take any prescriptions, right? Not necessarily. Unfortunately even if you do not take any prescriptions when you complete your Medicare enrollment and decide not to enroll in a Part D plan, you are going to face a late enrollment penalty in the future if you do decide to ever enroll. This penalty is 1% per month you delay your enrollment multiplied by the base modal premium, which is subject to change each year. Unfortunately, there are rules on when you can enroll or disenroll from any Part D drug plans. You can visit the Medicare Part D section that is on this website. Here, you can get more details about how your drug coverage under Medicare will work for you and your ongoing healthcare needs. Give us a call at 877-88KEITH (53484), an experienced agent will review your Medicare Part D options. Medicare Supplement Plans (Medigap)
As we mentioned before, there are other “parts” of Medicare that don’t fall into these lettered pieces. One very important part is a Medicare Supplement Plan, also known as a MediGap Plan.
MediGap plans are alternatives to Medicare Advantage plans.
Many people choose to remain under Original Medicare and enroll in a Medicare Supplement plan to fill in the gaps in coverage left by Original Medicare. Unlike a Medicare Advantage plan, someone with Original Medicare and a Medicare Supplement plan can utilize ANY doctor who accepts Medicare as a form of insurance, in all 50 states. That’s right! No more networks or out-of-network charges. This is an extremely beneficial aspect of MediGap plans, as we as Medicare beneficiaries want the ability to see the best doctor’s possible for any health needs that may arise.
Although Medicare Supplement plans have higher premiums than Medicare Advantage plans, it doesn’t necessarily make the more expensive. Medicare is essentially a pay now or pay later system. With a MediGap plan, you pay upfront in the form of a monthly premium, but your out-of-pocket is minimal. With a Medicare Advantage plan, you pay-as-you-go in the form of copayments, deductibles, and out-of-pocket maximums. You don’t want to be afraid to use your plan because you are worried about the bills that may arise!
There is a wide choice of 11 supplement plans, but the choice can usually be boiled down to 4 easy to understand options-
The 4 most popular Medicare supplement options are:
If you click on each option it will take you to a video that explains the benefits in depth.
* Since January 1, 2020, Medigap plans won’t cover Part B deductibles. Therefore, Plans C and F won’t be available to those individuals new to Medicare starting on this date.
Give us a call at 877-88KEITH (53484), an experienced agent will walk you through your Medicare Supplement plan options.
What Medicare Parts do I Truly Need?
When it comes to your healthcare, if Medicare is your only coverage, you need both parts of Original Medicare. These are going to be both Parts A and B. If you want to be eligible to enroll in other Medicare supplement plans or the Medicare Advantage plan, you will have to enroll in Part A and B of Medicare. Most people need Part D to help cover additional expenses in their healthcare, like prescriptions. That could be added as standalone coverage alongside the Original Medicare and as a Medicare supplement. You can also look into any Medicare Advantage plans that may have a built-in Part D drug plan. Before you enroll in Part D of Medicare, make sure that your Medicare Advantage plan doesn’t already cover your prescription drugs. There’s no need to register in any more parts than you need. Keep in mind that Part D is voluntary. If you already have drug coverage with your current plan, whether it be a Medicare Advantage plan or outside insurance, you will not need to worry about Part D of Medicare.
Is Any Medicare Mandatory?
Unless you have a specific amount of coverage, say through your employer, you will have to pay significant penalties if you enrolled late into Medicare. To avoid any of these penalties, you must be enrolled in both Medicare Part A and B during your initial enrollment period. Of course, this is unless you have other coverage that will make up for not having Medicare. Even though Medicare is considered insurance, it is not mandatory.
Remember that once you enroll in any of your Social Security income benefits, your enrollment in Medicare Part A will be automatic. You cannot collect Social Security without being automatically enrolled in part A of Medicare as both of those two are linked together.
While dealing with Medicare can prove challenging at times, ensuring you have a clear understanding of what each part of Medicare does will help you make the correct choices for your current and future healthcare needs. At times, Medicare can be a beast of a program for you to deal with. With the proper knowledge at your disposal, you will have no problem picking out which parts are perfect for you. You’ll be confident enough to know what to do when it comes time to enroll.
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