Services
What We do
Medicare Services
What is Medicare?
Medicare is a national single-payer insurance health insurance program administered by the Centers for Medicare and Medicaid Services (CMS) of the United States Federal Government.
In 1961 President Eisenhower held the first White House Conference on Aging. In this meeting, the creation of a health insurance program for social security recipients was proposed. In 1965 President Lyndon Johnson and Congress enacted what we now know as Medicare under Title XVIII of the Social Security Act to provide health insurance to people 65 and over.
Over time, the program has undergone several changes in the half century since its inception. More services, such as benefits for speech, physical, and chiropractic therapy were added in 1972.
The program added payments to Health Maintenance Organizations (HMO’s) in the 1980’s. This is a measure to control costs and to guide the member to more appropriate care. In the Clinton administration, Part C, or Advantage plans were introduced. President Bush then introduced Part D in 2006, which covers prescription drugs.
In general, people age 65 and older, younger people with disabilities and people with End-Stage Renal Disease (ESRD) can enroll. You are eligible for Part A if you are 65 or older, and you or your spouse worked and paid Medicare taxes for at least 10 years. If you have been receiving Social Security disability for 24 months, you would also be eligible.
Medicare Part A: What does Part A cover?
Hospital care: hospital services, which include meals, nursing, semi-private rooms, drugs as part of your inpatient treatment, and hospital services and supplies. This includes acute care, critical access, and long-term care hospitals as well as inpatient rehabilitation facilities
Skilled Nursing Care: Medicare Part A covers skilled nursing care in skilled nursing facilities under certain conditions for a limited time.
Nursing Home Care: This is only covered if it pertains to a skilled nursing facility. If this is medically necessary for you to have skilled nursing care.
Hospice Care: is generally given in a person’s home but may also be administered in a hospice inpatient facility. This will depend on the type of terminal illness and related conditions as well as the plan of care your hospice team executes.
Home health services contain certain eligible home health services such as continued occupational services, speech-language pathology services, physical therapy and intermittent skilled nursing care. These services are only covered when the services are specific and an effective treatment for the specific condition. It must also be safe and completed in a timely manner. To be eligible, your condition must be expected to improve in a reasonable time and in a generally predictable period, or if you need a skilled therapist to safely and effectively do the required maintenance therapy for your condition. Medicare requires the agency be certified and your doctor must certify that you are homebound.
Medicare Part B: What does Part B cover?
In general Part B, is medical insurance for regular doctor’s visits and testing. This includes anything that is medically necessary, such as surgeries and follow ups for surgeries. Part B covers, clinical research, ambulance services, durable medical equipment, mental health and it covers getting a second opinion before a surgery. It also covers part-time home health and rehabilitative services, such as physical therapy; if they are requested by your physician to treat your condition.
Medicare Part C: What is Part C?
If you are currently enrolled in part A and part B, you can choose to enroll into a Part C, or Medicare Advantage plan. These plans are offered by private insurance companies to coordinate and provide hospital and medical benefits for beneficiaries. A Medicare Advantage Plan is required to cover everything that original Medicare covers, including emergency and urgent care. These plans will usually offer additional benefits such as coverage for routine vision or dental services, dentures and more. Some Medicare Advantage Plans have a $0 premium, but you must continue to pay the Part B premium. These plans have networks, as well as co-pays and set out of pocket maximums.
Some of the different types of Medicare Advantage plans are as follows:
HMO: (Health Maintenance Organization plan): Allows you to see doctors in-network, usually with lower monthly premiums, but the member does not have any coverage outside of the network for any services other than true medical emergencies.
PPO: (Preferred Provider Organization plan): These plans will allow you to see in and out of network providers, which gives you the ability to see doctors in network or out of network and still have coverage. Out of network providers will usually include a higher out of pocket for the consumer.
PFFS: (Private Fee for Service plan): The plan has a predetermined set fee for servies it will pay when you get care, and the treating doctor must accept those terms and conditions. If the doctor will not accept the terms, the plan does not cover the services.
SNP: (Special Needs Plan): This is a plan that is available for people who have certain medical needs. The three different SNP plans cover Medicare beneficiaries who are living in institutions. This also covers those who are dual eligible for Medicare and Medicaid. And lastly, those with chronic conditions such as diabetes and heart conditions. These plans typically include prescription coverage as well.
Part D: What is Part D?
Part D is also called the Medicare prescription drug benefit, subsidized through the federal government to help pay the cost of prescription drugs and prescription drug insurance premiums for Medicare beneficiaries. President George Bush, in 2003 signed the legislation that enacted Part D as part of the Medicare Modernization Act of 2003. This went into effect on January 1st, 2006. Part D plans can vary in coverage, premium, deductibles and prescriptions included on the formulary (list of covered prescriptions).
Need Extra Help with Medications?
Harris Insurance Agency can see if you qualify for extra help with prescription medications. Did you know that one in four people on Medicare qualify for extra help with prescriptions but have never applied?
Medicare Supplement or Medigap
Medigap or Medicare Supplement plans are policies that provide insurance through private companies that help fill cost sharing gaps. Medicare Supplements may help pay for Medicare deductibles, coinsurances, and copayments. You have up to 10 different Medigap plans to choose from: A, B, C, D, F, G, K, L, M, and N. Each lettered Medigap offers a different set of benefits, but all plans with the same letter must offer the same benefits (regardless of the company you buy it from). Premiums vary, depending on both the plan you choose and the company you buy it from.
Resources
Found on Medicare.gov:
- Medicare and You Handbook
- Choosing a Medigap Policy Handbook
- Standardized Medicare Supplement Plans Chart
—From Medicare.gov website
Health care Services
Health insurance in the United States is any program that helps pay for medical expenses, whether through privately purchased insurance, social insurance, or a social welfare program funded by the government.[1][2] Synonyms for this usage include “health coverage”, “health care coverage”, and “health benefits”. In a more technical sense, the term “health insurance” is used to describe any form of insurance providing protection against the costs of medical services. This usage includes both private insurance programs and social insurance programs such as Medicare, which pools resources and spreads the financial risk associated with major medical expenses across the entire population to protect everyone, as well as social welfare programs like Medicaid and the Children’s Health Insurance Program, which both provide assistance to people who cannot afford health coverage.
In addition to medical expense insurance, “health insurance” may also refer to insurance covering disability or long-term nursing or custodial care needs. Different health insurance provides different levels of financial protection and the scope of coverage can vary widely, with more than 40% of insured individuals reporting that their plans do not adequately meet their needs as of 2007.[3]
The share of Americans without health insurance has been cut in half since 2013. Many of the reforms instituted by the Affordable Care Act of 2010 were designed to extend health care coverage to those without it; however, high cost growth continues unabated.[4] National health expenditures are projected to grow 4.7% per person per year from 2016 to 2025. Public healthcare spending was 29% of federal mandated spending in 1990 and 35% of it in 2000. It is also projected to be roughly half in 2025.[5]
—From Wikipedia, the free encyclopedia
What We Can Do For You
We here at Harris Insurance Agency will help you navigate the Open Enrollment process with the Healthcare Marketplace. If open enrollment has ended or you find yourself in a Special Election period, we can help you as well. We also offer off the market options to fit almost every need.
