What's Cover & What's Not On Medicare Supplement & Advantage Plan

Medicare is a government health insurance program for people who are 65 or older or have certain disabilities and are younger than 65.

Medicare covers a lot of health care costs, but there are some things it doesn't pay for that can leave people with large out-of-pocket costs. Medigap, which is another name for Medicare Supplement plans, is made to fill these gaps.

What Medicare Supplement Cover

Standardized and marked with letters (A, B, C, D, F, G, K, L, M, and N), Me dicare Supplement plans offer different amounts of coverage. But all plans come with the same basic perks, which are:

• Medicare Part A coinsurance and hospital costs: Pays for coinsurance and hospital costs for up to an extra 365 days of overnight hospital stays after Medicare benefits run out.
• Medicare Part B coinsurance or copayment: Covers the coinsurance or copayment for Medicare Part B services, such as doctor visits, lab tests, and outpatient services.
• Blood: Covers the first three pints of blood a person gives each year.
• Coinsurance or copayment for hospice care under Medicare Part A: This pays for the coinsurance or copayment for hospice care under Medicare Part A.
• Skilled nursing facility care coinsurance: This covers the Medicare Part A coinsurance for skilled nursing facility care.
• Part A deductible: Pays for the Part A deductible for inpatient hospital care.
• Part B deductible: This covers the Part B expenses deductible.
• Part B excess charges: Part B covers the extra fees that some doctors may charge on top of the Medicare-approved amount for their services.
• Foreign travel emergency coverage: Coverage for emergency medical care outside of the U.S. while traveling outside of the U.S.   

What Medicare Supplement Plans Do Not Cover

Not everything is covered by Medicare Supplement plans. Some of the things that these plans do not cover are:

• Prescription drugs: Medicare Supplement plans do not cover prescription drugs. Beneficiaries must sign up for a different Medicare Part D plan if they want coverage for prescription drugs.
• Hearing, vision, and oral care: Medicare Supplement plans do not cover regular care for your teeth, eyes, or ears.
• Long-term care: Long-term care, like care in a nursing home, is not covered by Medicare Supplement options.
• Private-duty nursing: Private-duty nursing is not covered by Medicare Supplement plans.
• Hearing aids are not covered by Medicare Supplement plans.
• Eyeglasses: Medicare Supplement plans do not cover eyeglasses or contact lenses.  

Medicare is a government health insurance program for people who are 65 or older or have certain disabilities and are younger than 65. Medicare covers a lot of health care costs, but there are some things it doesn't pay for that can leave people with large out-of-pocket costs. Medigap, which is another name for Medicare Supplement plans, is made to fill these gaps.

What Medicare Advantage Plans Cover

Medicare Advantage plans cover the same things as Original Medicare, but they may offer extra benefits like:

• Coverage for prescription drugs: Many Medicare Advantage plans, also called Medicare Part D, include coverage for prescription drugs.
• Dental, vision, and hearing care: Some Medicare Advantage plans cover regular dental, vision, and hearing care that Original Medicare does not.
• Fitness and wellness programs: Some Medicare Advantage plans help people stay healthy by giving them gym passes, fitness classes, and wellness programs.
• Transportation: Some Medicare Advantage plans include rides to and from doctor's visits.
• Over-the-counter (OTC) benefits: Some Medicare Advantage plans have OTC benefits that let plan members use their plan benefits to buy things like vitamins and pain medicines that don't need a prescription.

What Medicare Advantage Plans Do Not Cover?

Even though Medicare Advantage plans offer extra benefits, they don't cover everything. Some of the things that these plans do not cover are:

• Out-of-network care: Medicare Advantage plans have a network of healthcare providers, and if a beneficiary gets care from a provider outside the network, they may have to pay some or all of the cost.
• High out-of-pocket costs: Medicare Advantage plans may have higher copayments, deductibles, and fees than Original Medicare.
• Non-emergency care while going outside the U.S.: Medicare Advantage plans do not cover non-emergency care received outside the U.S.
• Long-term care: Long-term care, like care in a nursing home, is not covered by Medicare Advantage plans.
• Cosmetic treatments: Medicare Advantage plans don't pay for non-medically necessary cosmetic procedures like plastic surgery.
• Experimental medicines: Medicare Advantage plans don't cover experimental treatments that haven't been approved by the FDA yet.

How To Choose Between Medicare Advantage and Medicare Supplement Plans

Private insurance companies offer Medicare Supplement plans, also called Medigap plans. These plans help pay for Medicare Part A and Part B costs like deductibles, co-payments, and co-insurance. Medigap plans usually have higher annual premiums than Medicare Advantage plans, but they may cover more services and have lower out-of-pocket costs.

Private insurance companies offer Medicare Advantage plans, which are a different way to get Medicare benefits. These plans must offer the same benefits as Original Medicare (Parts A and B), but they may also offer extra benefits like support for prescription drugs, services for your eyes, teeth, and ears, and wellness programs. Most of the time, Medicare Advantage plans have lower annual premiums than Medicare Supplement plans, but some services may cost more out of pocket.

The MA plans, also known as Part C Medicare, are available in Idaho and can provide minor health benefits like prescription drug coverage, vision, hearing aids, fitness, and telehealth. Original Medicare does not cover major medical services. You must be enrolled in Medicare Part A Medicare Part A for hospital coverage for those with Original Medicare. Part B for medical coverage for doctors visits and tests. Medicare Part B Medicare Part B for medical coverage is for individuals with Original Medicare. This includes doctor visits, specialists, diagnostics and lab tests, as well as durable medical equipment. Part A covers hospital inpatient care .

In the end, you should choose between a Medicare Advantage plan and a Medicare Supplement plan based on your own cash and health care needs. Think about how you currently use health care, how much you can pay for fees and out-of-pocket costs, and which doctors and hospitals you prefer. You might also find it helpful to talk to a licensed insurance agent who can help you understand your choices and choose the plan that best fits your needs.

Medicare Advantage Boise & Meridian, Idaho

Medicare Advantage Plans to provide additional benefits and features to Original Medicare. Different plans may be available to members in certain areas. Plans may also include prescription drug benefits under Medicare Part D. An online search for Idaho Medicare Insurance Options. Find information on Medicare in Idaho, including Medicare assistance programs. Idaho Commission on Aging (abbreviated ICOA) administers the federal programs that Idaho seniors receive, which includes Medicare beneficiaries. The Older Americans Act covers its activities and seniors. It enables the agency to create policy and coordinate priorities. Both disabled and older people can access the ICOA for assistance in Idaho. For more assistance, contact Chris Antrim Insurance and let's get you ready!

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