Overview Of Medicare And Private Insurance Plans
As you know, Medicare is available to people who have reached the age when they’re eligible for social security, while private insurance plans are intended to cover younger individuals, families and employee groups.
Medicare and private insurance plans work in similar ways. The plans pay a certain portion of the cost of treatment, drugs and medical devices, while the patients pay part of the cost, which is known as a copay. The amount of the copay varies with the insurance plan, treatment types, drugs and medical devices.
Generally, Medicare and private health plans have similar rules, but private plans can vary. For details of private coverage, you should consult the material that came with your health insurance plan.
We accept Medicare and most major health insurance plans. If you have questions about your Medicare drug coverage or private coverage, we invite you to contact us. We have a staff of billing experts who can assist you. Medicare is complicated and plan options changes every year. We can help you simplify the process and understand your options to ensure that you select the appropriate Medicare Part D plan that’s best for you. We can also help with advice about your private insurance plan.
Sometime, the various parts of Medicare can be confusing, especially for people who are about to or have just qualified for coverage under it. Here is a breakdown of the various parts of the program.
Ask us about your coverage or visit the official U. S. government Site for Medicare at medicare.gov
offers benefits that cover hospital stays, home healthcare and hospice services. There is generally no fee to enjoy the benefits of Part A. Instead, payment is due when you make use of the benefits.
covers physician visits, lab tests, ambulance services and home medical equipment. It does require payment of a monthly premium, whether or not you make use of the services. The amount of the premium you pay varies with your income. It ranges about $115 a month to about $370 a month. You can elect to have the premium deducted from your Social Security check and most people find this option convenient.
is an optional program that covers prescription drugs. There are different plans within Medicare Part D. The coverage, fees and copays vary with the plans.
Many Medicare participants elect to join a Medicare Advantage Plan, sometimes referred to as Part C.
Total Care RX can advise you about Medicare Part D and the benefits the various plans in Part D offer in relation to the drugs you take.
When you reach the age of 65, you qualify for Medicare. At this time, it’s usual to transition from private insurance to Medicare, although some individuals elect to retain their private coverage in addition to Medicare.
There are exceptions to the age limitation. For example, if you’re under 65 but have permanent kidney failure, you can qualify after three months of dialysis. Or if you’re permanently disabled and are eligible for social security, you can be covered by Medicare after you’ve received disability benefits for 24 months.
Medicare is the health insurance plan established and run by the U. S. Government. It was created to provide health insurance for older Americans.
If you’re 65 or older, you qualify for Medicare.
In certain instances, you may also qualify if you’re under 65; for example, if you’re permanently disabled and eligible for Social Security. In this case, your Medicare coverage can begin 24 months after your disability benefits start. You may also qualify if you have permanent kidney failure. In this instance, your Medicare coverage can begin 3 months after your dialysis begins.
Medicare Part A covers hospital stays, home healthcare and hospice services, while Medicare Part B covers physician visits, lab tests, ambulance services, and home medical equipment.
Medicare Part D covers drugs. Participation in the program is optional. We highly recommend that you elect to participate.
There is generally no fee for Part A. Instead, payment is due when you make use of the benefits.
Medicare Part B does require payment of a monthly premium, whether or not you make use of the services. The amount of the premium you pay varies with your income. It ranges about $115 a month to about $370 a month. You can elect to have the premium deducted from your Social Security check and most people find this option convenient.
Medicare Part D is an optional program that covers prescription drugs.There are different plans within Medicare Part D. The coverage, fees and copays vary with the plans.
There are also Medicare Supplement Plans, often referred to as Medicare Advantage Plans, which are administered by major private health insurance plans that have a Medicare contract.
Generally, all drug coverage comes under Part D. However, some drugs are covered by Medicare Part B, including some nebulizer drugs, some infused drugs, certain immunosuppressive drugs, some oral anti-cancer medications, as well as most parenteral nutrition.
Want to know more? Ask us about your Medicare coverage or visit the official U. S. government Site for Medicare at https://www.medicare.gov/
To help you with your Medicare coverage and the questions you may have, we’ve put together a library of resources for your easy reference.
It’s part of our effort to provide our customers with Total Care RX service.
Please, browse the resources for information that may be helpful to you.
If you have any questions about Medicare that aren’t answered here, we invite you to contact us. We’re here to help.
For a complete discussion of Medicare, you can also visit https://www.medicare.gov
It’s helpful to understand the terms that are used to describe Medicare. Sometimes, they can be confusing. The U. S. Government provides a complete glossary of terms at its site.
The terms are arranged in alphabetical order and there is an easy alphabet-based navigation bar at the top of the page.
For instance, if you have a question about benefits, just click on the “B” and a description of all the terms that begin with that letter will be listed with a definition
To access the glossary, just go to https://www.medicare.gov/Glossary/a.html
Helping you understand Medicare is part of our dedication to providing Total Care RX pharmacy services to our customers.
If you still have a question about Medicare after consulting the glossary, we invite you to contact us. We’re here to help.
Most Medicare drug plans have a coverage gap, which is a temporary limit on the amount the plan will cover.
The gap only begins after you and your plan have spent a certain amount for drugs.
If you get Extra Help to pay Part D costs, you won’t be affected by the gap. Extra Help is available to people who receive Medicaid.
When you enter the coverage gap, you receive a 50% discount on covered brand-name drugs. The discount is paid by the drug manufacturer. The remaining 50% counts as out-of-pocket spending, which helps you get out of the coverage gap.
When it comes to covered generic drugs, you pay 86% of the plan’s cost for the drugs until you reach the end of the coverage gap.
Certain other items count toward the coverage gap, including your yearly deductible, coinsurance, as well as your copayments. Other items don’t count toward the coverage gap, including the drug plan’s premium and the amounts you pay for drugs.
Talk to your doctor or other healthcare provider to make sure you’re taking the lowest-cost drug available that works for you.
Consider changing from brand-name drugs to generics.
Choose a Part D Plan That Offers Additional Gap Coverage. These plans may have a higher monthly premium.
You can find out if a Patient Assistance Program exists for the drugs you take by visiting Medicare’s Pharmaceutical Assistance Program site.
Want to know more? Ask us about your Medicare coverage or visit the official U. S. government Site for Medicare at https://www.medicare.gov
Total Care RX feels strongly that exceptional patient care goes beyond the prescription. Patients require the proper education to fully understand and get the most benefit from their medications. This is what being a specialty pharmacist means to us.
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