Health Insurance Blog & News

Medicare Guide for Seniors and the many parts making up this important coverage

Medicare Guide

How can a medicare guide help you?

The Medicare Guide for seniors can help you understand the program and how to get the most out of it. The guide covers topics such as what benefits each program offers and what the enrollment process is like. It can also help you understand Medicare Advantage plans and Prescription drug coverage. Once you know what these programs offer, you’ll be well on your way to a more enjoyable retirement.

Medicare Advantage plans

The market has seen steady growth in enrollment over the last decade. By 2022, nearly half of all beneficiaries will be enrolled in one of these plans. But the growth has been uneven across the country. Only 25 states and Puerto Rico will see more than 50 percent of beneficiaries enrolled in Medicare Advantage plans, and a growing number of counties will see 60 percent or more enrollment. Still, the market is dominated by a few large companies. In 2022, UnitedHealthcare and Humana will have a combined enrollment of 46 percent of all Medicare beneficiaries.

These plans differ in their cost, network of providers, and out-of-network costs. There are also different requirements that must be met to participate in the Medicare Advantage market. For instance, some plans may only cover certain types of services, such as preventive care, while others may not. In addition to the difference in costs, these plans vary in their benefits and co-payment amounts.

Before selecting a plan for yourself, gather as much information as you can on each plan. Be sure to compare costs, benefits, and eligibility requirements before making a final decision. You can also seek assistance from your local Area Agency on Aging to get objective insurance counseling. SHIP can help you decide on the best Medicare Advantage plan for your specific needs.

Medicare Advantage plans for seniors are gaining in popularity because of their range of benefits. These plans have lower costs than traditional Medicare, and are more likely to be accepted by people newly eligible for Medicare. Additionally, many plans are coordinated, which may be appealing to recent retirees. However, older retirees may prefer traditional fee-for-service medicine.

A healthcare company called Alignment Healthcare has been serving Medicare Advantage members in North Carolina for several years. In 2021, the company plans to expand its footprint in North Carolina and Nevada, which will provide more coverage for this vulnerable senior population. Its plans will cover around one million people in these counties. Further, Alignment Healthcare’s 24/7 ACCESS On-Demand Concierge will help members with any questions they may have.

Special Needs Plans are plans designed specifically for people who have certain medical conditions or low incomes. The company also has Medicare and Medicaid plans for people who are dually eligible. Chronic Condition SNPs, for example, cover certain medications. Dual-eligible SNPs include additional benefits like hearing and dental coverage.

The cost of a MA Plan varies depending on the network of doctors. Some of the lowest-cost MA Plans require members to visit only doctors within their network. However, they may also have restrictions on the kinds of services they can receive. Some may not offer vision or hearing coverage.

Prescription drug coverage

If you are a member, you can get prescription drug coverage through your health insurance plan. This coverage is known as Part D, and it covers the cost of prescription drugs. Original Medicare covers inpatient hospital care, skilled nursing facility care, and outpatient care, but it does not cover prescription drugs. Therefore, you should sign up for a Part D or Medicare Advantage plan.

Many plans offer basic coverage but require a coinsurance rate for certain drugs. Other plans have tiers, so you pay a set amount when you fill a prescription. Different people move through different stages of drug coverage. Some people may stay in the deductible stage, while others will only move to the initial coverage stage. If you need expensive medications, however, you may move into the catastrophic stage.

When you’re looking for prescription drug coverage, you can visit the Centers for Medicare and Medicaid Services website to learn more about the options. Many plans include prescription drug coverage. But you should know that Part D plans can be expensive. You may need to pay a monthly premium and other out-of-pocket costs, and you may be eligible for the Medicare Savings program or Extra Help to lower the cost.

Part D has a coverage gap that you need to be aware of. Part D covers part of the cost of prescription drugs, but once you reach a certain threshold, you’ll have to pay more. If you go over this limit, you’ll be subject to the “donut hole” and will be required to pay more than 25% of the cost of your prescription drugs.


Check out our monthly newsletter and subscribe to your topics!

Subscribe to our Newsletter

Ready to get started, Get our Newsletter and join the Community!

Health Insurance Articles & News

Other Health Insurance articles that may be of interest