If you’re a Medicare beneficiary, it’s important to be informed about the plan options available. Medicare is the largest health insurance program in the United States, and you’ll want to make sure your coverage meets your specific needs. For Medicare Help, EmblemHealth is here to assist you in navigating this confusing system and ensuring you have the correct coverage to meet your needs.
Medicare covers most hospital and doctor visits, as well as some home care services and some medical equipment. It also provides coverage for prescription drugs. Medicare Advantage plans are available in many areas and usually offer additional benefits like dental, vision and hearing.
Original Medicare Parts A and B is free for most people because they or their spouse paid into the system through payroll taxes while working. The only cost to most people is the monthly Part B premium. If you choose to add Medicare Part D drug coverage, it will generally have a separate premium. The amount you pay for drugs is based on your income and the type of plan you choose. Some plans have yearly limits on the total you pay for services, while others have specific limits on in-network and out-of-network costs.
You may also be able to get help with your Medicare Part D drug costs through a program called Extra Help. This helps pay the plan’s monthly premium, annual deductible and lowers your prescription copays. Eligibility depends on your income and resources, which include your bank accounts, cash at home, investments like stocks and bonds, personal property and real estate. Certain assets, like your home, car and life insurance policies, back payments from Social Security or SSI, burial plots and contracts and burial contracts don’t count toward these limits.
You’ll also need to decide whether you’re a good candidate for Medicare Advantage, which combines the benefits of Parts A and B into one plan with a single monthly premium. There are a lot of different Medicare Advantage plans available, so it’s important to do your research before enrolling. Choose a plan with the doctors you like and consider what other features you may need, such as a PPO that lets you see specialists without referrals or an HMO that includes a network of hospitals.
Whether you have Original Medicare, a Medicare Advantage plan or prescription drug coverage from an employer or union, your state may provide programs to help with your Medicare costs. Contact your state’s Health Insurance Assistance Program for information about the details.