Description: This passage is mainly about healthcarefirst login. In this passage, we can learn about what Medicare is, who is eligible for it and how it works. Besides, we can know the specific parts of them.
What is Medicare? Who is eligible for it? How does it work? Medicare is a health insurance provided by the US government for people over 65 or for some disabled persons. Medicare is made up of four parts, Part A, Part B, Part C and Part D. There is another option called Medicare supplement that we will discuss later.
Let’s talk about what the letters mean. Parts A and B are what are known as Original Medicare, which most people are eligible for when they turn 65. Part A is automatic, parts B, C and D on the other hand are optional. Part A is hospital insurance that helps pay for things, such as inpatient hospital stays, skilled nursing care, hospice and limited home health care.
If you or your spouse has worked a minimum of 10 years and paid for at least 40 quarters of Medicare taxes, you are automatically enrolled in Part A with no monthly premium. Part B is medical insurance that helps pay for doctors visits, outpatient procedures, diagnostic tests, medical supplies and vaccines.
Preventive benefits, such as certain screenings, mammograms diabetes and prostate screenings are also included. Most people have to sign up for Part B, and it typically comes with a standard monthly premium, which is determined by your income. To make things easier, your Part B premium can be deducted from your monthly Social Security check.
Medicare supplement plans which are also known as Medigap plans act as secondary insurance to Medicare. Medigap plans are designed to help cover some of the costs not be covered by Original Medicare Parts A and B, such as deductibles, co-pays and coinsurance.
With Medigap plans, you can also choose any doctor or health care provider that accepts medicare. Medigap plans don’t cover things such as vision, hearing, dental or long-term care and they don’t cover prescription drugs. Keep in mind with a Medigap plan, you pay for both Medicare Part B monthly premium and your Medigap plan premium.
Original Medicare Parts A and B and Medicare supplement don’t cover prescription drugs, that’s where Medicare Part D comes in. Medicare Part D is offered by insurance companies, such as Highmark. It helps pay for prescription drugs. Each prescription drug plan has a list of generic and brand name drugs that are covered by that plan, it is called a formulary.
Each drug is assigned to a tier which can terminate drug. Highmark has a transition process to accommodate the needs of new enrollees, whose current regimens include drugs that are not on the plans formulary, or those drugs that require prior authorization. You can get Part D either as a stand-alone plan or as part of a Medicare Advantage plan. It’s up to you and your needs.
Here’s how Medicare Part D works. You can sign up for Part D when you first become eligible for Medicare. Part D is optional, but if you do not enroll in a Part D plan when you first become eligible, there may be a late enrollment penalty. The late enrollment penalty is calculated by multiplying one percent of the national based beneficiary premium, times the number of months you went without credible prescription drug coverage.
By enrolling in Medicare Part D when you become eligible, you can save money on prescription drugs, manage your health-care budget better and have prescription drug coverage in the place where your health needs change in the future.
Prescription drug coverage can be broken into four stages deductible, initial coverage, coverage gap and catastrophic coverage. The deductible is the amount that you must pay each year for your prescriptions, before your Medicare prescription drug plan begins to pay its share of your covered drugs.
Most of Highmark Medicare Advantage plans have a zero-dollar deductible, so coverage begins with the first dollar you’re charged for prescriptions. Once you enter the initial coverage, you pay a co-payment or coinsurance for your covered prescriptions. And Highmark pays its share for covered drugs until the combined amount reaches the yearly amount, which is three thousand seven hundred and fifty dollars in 2018.
Here is an example. Let’s say a thirty-day supply of a preferred generic prescription drug costs $100. With Highmark Part D plans, you should pay a copay for example five dollars, and Highmark will pay the remainder of the cost.
In this example, it’s ninety five dollars. However at the total drug cost of $100 is the amount that will count towards the initial coverage limit of three thousand seven hundred and fifty dollars in 2018.
Most Medicare drug plans have a coverage gap, which is also called the donut hole. The coverage gap begins after you and your drug plan together have spent a certain amount for covered drugs in 2018.
Once you enter the coverage gap, you pay thirty five percent of the plans cost for covered brand-name drugs, and 44 percent of the plans cost for covered generic drugs until you reach the end of the coverage gap.
Not everyone will enter the coverage gap, because their drug costs won’t be high enough. Once you get out of the coverage gap, you automatically move into the catastrophic coverage period. With catastrophic coverage, you only pay a small coinsurance amount or co-payment for covered drugs for the rest of the year.
Are you looking for an all-in-one plan that includes medical and drug coverage? A Medicare Advantage plan from Highmark may be right for you. Part C plans, which are also called Medicare Advantage are offered by private insurance companies, such as Highmark, and they act as primary insurance instead of Original Medicare.
Medicare Advantage plans help with hospital costs, doctor’s visits and other medical services that are covered by Original Medicare. Besides Part C plans offer worldwide emergency in urgent care, and it can include coverage for prescription drugs, routine vision, hearing, dental and even gym memberships.
All of these come in one plan with one member ID card. So how does Medicare Advantage work for starters? You have to be eligible and enrolled in Original Medicare Parts A and B, you also need to pay for your Medicare Part B premium along with your Medicare Advantage plan premium on a monthly basis.
When you have a Medicare Advantage plan, you pay a co-payment or coinsurance for the services you use, and not for those you don’t. Highmark’s Preferred Provider Organization Plans, which is also known as PPOs, offer more choices and doctors by letting you choose services out of the network.
But you may have to pay more for those out of network services to help keep your cost down. You will need to pick a doctor in Highmark Network. If you choose a Health Maintenance Organization plan, which is also known as HMO, that may be the fastest explanation of the Medicare alphabet ever attempted. Hopefully that gives you a basic understanding of Medicare and how it works. You’re on the road to choose the right plan for your health-care needs.