Learn More About the Coverage Types Available Before Applying for Medicare

When it comes time to apply for Medicare, the status of your health and the insurance plans available in your area play significant roles in choosing the Medicare plan that is right for you. Although traditional Medicare offers the same benefits at the same cost no matter where you live, the benefits and costs associated with enrolling in a private Medicare insurance plan such as Part C, Part D, and Medigap vary. Therefore, it helps to assess your medical needs and determine how much you can afford to pay for a health plan before choosing a Medicare plan that meets your particular needs.

Medicare Part A and Part B

Although Medicare Part A (hospital insurance) and Part B (medical insurance) cover hospital care and out-patient services medically necessary to treat an illness or other health condition, the plan doesn't cover medical expenses such as eye exams, dental care, or prescription drugs. If you have a chronic health condition, make frequent doctor visits, need surgery, or require an extended period of home health care or skilled nursing care, you may need more health insurance coverage than what Medicare provides.

For instance, you may have to purchase additional hospital and medical coverage or pay for some home health services out of pocket if your doctor orders:

  • home health services that Medicare doesn't cover

  • skilled nursing care or therapeutic services, such as physical therapy, occupational therapy, or speech-language pathology, more frequently than Medicare covers

  • home care services for longer than Medicare covers

Medicare Part A and Part B will not cover home health services if you need more than part-time skilled nursing care.

If you are admitted to a skilled nursing facility, Medicare Part A will only pay for the care you receive for a limited period of time. Admission to a skilled nursing facility must follow a hospital stay for a medical condition for which your doctor determines that you need 24-hour skilled care on a daily basis.

Medicare Part C and Part D

Since states and counties regulate Medicare Parts C and D coverage, the cost and benefits offered vary widely across the nation. Part C is a Medicare Advantage Plan, such as an HMO or PPO, which requires that you go only to doctors, hospitals, and other health care providers within the plan's network. Medicare Part D provides prescription drug coverage.

Since private insurance companies in each state that offer the plans process claims for Medicare, the companies determine if a particular service or medical supply is medically necessary and should be covered in that insurer's coverage area. Depending on where you live and the plan offered, your Medicare Advantage Plan may offer prescription drug coverage.

Medicare Supplemental Insurance

Medicare supplement insurance plans—commonly referred to as Medigap coverage—offer the same benefits regardless of the state in which you reside. However, the cost can vary as private insurance companies are allowed to set their own premium rates which differ from one company to another.

Even medical services that Medicare covers are not covered fully. Medicare supplemental plans provide additional coverage, but you must enroll in both Medicare Part A and Part B to be eligible for supplemental Medicare insurance. For more information and assistance choosing the right plan for your needs, talk to a company like Continental Insurance Agency, LLC.