Medicare is the federal health insurance program for Americans aged 65 and older.
One of the most popular federal programs in United States history, it enrolled 61.2 million beneficiaries in 2019. Experts estimate enrollment will rise to 79 million by 2030. Along with Social Security, Medicare is the solution that allows older Americans to maintain a strong quality of life after retirement. For all its advantages, however, Medicare can also be confusing.
For example, most people do not realize that only 10% of Medicare beneficiaries rely exclusively on this program to meet all of their medical needs. Nor do they necessarily know about the complex schedule of out-of-pocket costs that can apply to different procedures.
Medicare is especially popular in Central Florida communities like DeLand, Victoria Hills, Deltona, Astor, DeLeon Springs, Orange Springs, and others. In the region around Orange City and Orlando, thousands of qualifying seniors start Medicare benefits every year. But to truly enjoy life after retirement, making informed decisions about Medicare is crucial.
What All Central Florida Seniors Should Know About Medicare
To qualify for Medicare, you usually must be 65 or older, but you may qualify earlier if you are permanently disabled by an injury, accident, or health condition. Likewise, people with kidney failure that requires an organ transplant or dialysis may qualify right away.
Original Medicare has three parts:
- Medicare Part A: Part A covers inpatient hospital care, care in a skilled nursing facility, and hospice care. In less common situations, it can also cover the cost of some healthcare services provided at home.
- Medicare Part B: Part B covers certain services provided by doctors, outpatient care, preventive healthcare services, and some medical supplies, including durable medical equipment like canes.
- Medicare Part D: Part D provides prescription drug coverage, including some shots and vaccines.
The main alternative to Original Medicare is Medicare Advantage. Medicare Advantage can simplify your options by providing an “all in one” package. Medicare Advantage is also known as Medicare Part C, which is why there is no reference to a “Part C” under Original Medicare.
Medicare Advantage is a bundled plan that includes Medicare Part A, Medicare Part B, and usually Medicare Part D. These plans tend to have lower out-of-pocket costs than Original Medicare. Plus, they can offer benefits that are usually not covered under Original Medicare, such as vision, hearing, and dental health coverage.
The Most Asked-About Medicare Benefits For Central Florida Seniors
As they age, lots of people look forward to the quality healthcare they can access under Medicare.
Unfortunately, navigating all the different policy options that Medicare offers can be a challenge. No matter if you choose Original Medicare or Medicare Advantage, it’s normal to have questions. While you can get answers from a Medicare representative, this is often a complicated and time-consuming process.
Central Florida seniors need someone on their side – a local health insurance broker.
A health insurance broker is an insurance professional who develops deep familiarity with all of the different healthcare plans that are available in a given area. They are independent of any health insurance firm, providing the flexibility necessary to advise you according to your needs.
Let’s take a closer look at some of the more complex issues within Medicare.
Medicare Prescription Benefits
Medicare prescription drug coverage is known as Medicare Part D. You can use Medicare prescription benefits if you choose a Medicare plan that includes prescription drug benefits. You can also add drug benefits to certain Medicare plans, such as Original Medicare and some Medicare Cost Plans.
Medicare Part D prescription drug plans cover a wide range of prescription medications commonly used by Medicare beneficiaries. These include several drugs in protected categories, like those used to treat cancer, HIV, AIDS, and other very severe conditions.
To know whether your medications are covered by your plan, consult its formulary.
A plan’s formulary is its list of covered prescription drugs. Every plan, including Medicare plans, those on the ACA health insurance marketplace, and all private insurance plans, have their own formulary. The formulary can change from time to time, but generally includes the most common medications beneficiaries use.
One way that Medicare enrollees maximize the value of their benefits is the use of generic drugs.
Generic drugs are drugs that have been approved by the Food and Drug Administration as substantially similar to an existing brand name drug. They are required to be the same in dosage form, safety, strength, quality, and many other characteristics. The difference? They tend to be much less expensive.
If you are concerned about whether or not your needs are met under your existing Medicare prescription drug coverage, your doctor may be able to help you. They can recommend a generic alternative to your current medication if one exists. Generic drugs are not available as replacements for all brand-name drugs.
Durable Medical Equipment Under Medicare
Durable medical equipment includes items you may use every day to manage health conditions:
- Blood sugar meters
- Continuous Positive Airway Pressure (CPAP) devices
- Infusion pumps and related supplies
- Oxygen equipment and accessories
This is only a small selection of the many different durable medical equipment (DME) items that may be partly or fully covered under Medicare. To receive benefits that apply to these and other equipment pieces, your doctor must be enrolled as a Medicare provider.
Durable medical equipment benefits differ based on the type of Medicare plan you have. Under Original Medicare, you may be responsible for as little as 20% of Medicare-approved costs. Coinsurance and deductibles can also apply, which raises your out-of-pocket responsibilities.
When dealing with durable medical equipment, it’s important to know whether you will be expected to rent or buy the equipment. Renting provides for lower up-front costs, but buying may save you money in the long run. The right plan can help you spend much less on expensive equipment such as mobility scooters.
Original Medicare Supplemental Insurance
As an Original Medicare policyholder, you have the option of purchasing supplemental insurance.
Supplemental insurance can help you with costs not typically covered under Original Medicare. To give one common example, most Medicare drug plans have a coverage gap, also known as the “donut hole.” It begins when you have spent a certain amount on prescription drugs in a year. The limit was $4,130 in 2021.
Various insurers around the country offer supplemental insurance.
A Local Health Insurance Broker Can Help You Navigate Plan Parts, Coverage Gaps, And More
The choice of Original Medicare or Medicare Advantage is a big one – but it’s not the only one.
Instead of calling a Medicare representative, consider talking to a local health insurance broker right here in the DeLand area. You can finally get complete answers to all your questions. That includes whether or not there are Medicare alternatives that might meet your needs at a lower cost and with less to worry about.
For advice you can trust, contact us at Choice Health.