LEARN MORE ABOUT MEDICARE

Medicare 101 

Medicare may appear to be complex at first. When it comes to managing your benefits, having a firm understanding of the most fundamental elements of the Federal Healthcare program can help. If you have questions or need help deciding on the plan that’s right for you, call Simplex Healthcare Solutions.

There are four components to Medicare health coverage that you should be aware of.

Part A - Includes inpatient hospital and facility benefits.

Part B - Physician and outpatient benefits.

Part C/Medicare Advantage - a combination of Part A, Part B, and sometimes Part D.

Part D - Prescription drug coverage is provided through Part D, and Medicare Supplements fill up the gaps left by Parts A and B.

Who’s Eligible for Medicare

Please call our office if you are:

  • Turning 65 and need a Medicare Insurance Plan.
  • Losing your group health insurance for yourself or your spouse.
  • Disabled and qualified for Medicare Insurance.

Medicare Advantage Plans

With Medicare Advantage Plans, members may generally opt to combine the various components (Medicare Part A, Part B, and Part D, for instance) into one plan. There are often additional benefits available with Advantage Plans, including coverage for hearing, fitness, and more.

Medicare Supplement Insurance Plans

Medicare Supplement is sometimes called a Medigap policy, and it is designed to cover the items that your regular Medicare policy does not cover. Medigap plans vary and are accompanied by rules that determine what plans they may be combined with. It’s best to check with your Medicare provider for specific rules on your policy. In general, Medigap policies do not cover the following:

  • Long-term care
  • Vision or dental care
  • Hearing aids
  • Eyeglasses
  • Drug Plans
  • Private-duty nursing care

Medicare Prescription Drug Plans

Medicare Prescription Drug Plans are also called Part D plans. They offer coverage for some Medicare-covered prescription drugs. These plans can be used in combination with Original Medicare and Medicare Supplement Insurance Plans.

Medicare Special Needs Plans

These plans are variations of Medicare Advantage Plans and are in place to help those who may have unique financial or heath care needs. This category includes plans for Dual Special Needs, Chronic Special Needs, and Institutional Special Needs.

Gaps in Medicare

Although Medicare Parts A and B offer excellent financial security, there are still some coverage gaps that you should be aware of. Both Parts A and B have premiums, deductibles, and cost sharing for services with no out-of-pocket maximum, and they both have the option of placing a cap on the services or goods that would be excluded from coverage.

Have A Question? Give Our Team a Call at (888) 980-9334.

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