Medicare

At American Trust Insurance we UNDERSTAND MEDICARE and can help you find a plan that is the right fit for you.
Here are the basics and some things to consider when making your choices.

First you must understand your OPTIONS.

ORIGINAL Medicare (Parts A & B) is a federal health insurance program for people age 65 and older and others with certain disabilities.

Medicare pays fees for your care directly to the doctors and hospitals you visit. This has been referred to as "fee for service."

Original Medicare alone does not cover all of your hospital and medical expenses, and it does not include prescription drug coverage.

Part A helps with hospital costs. If you or your spouse paid into social security for at least 10 years, there is no monthly premium. Most people are
automactically enrolled in Part A when they first become eligible for Medicare.

Part B helps with doctor and outpatient care. You pay a monthly premium. Most people have to sign up for Part B.

Part D helps pay for prescription drugs. You can get Part D coverage as a stand alone plan or as a part of a Medicare Advantage Plan...explained later. Part D is voluntary but if not enrolled when you are first eligible and then you decide later to enroll there may be a penalty on your premiums unless you qualify for an exception.

Parts A and B do not cover most prescription drugs. And you pay deductible, copay and/ or coinsurance for any services not covered.

There are no annual out of pocket maximums under Part B so if you are seriously ill, the gaps and no out of pocket limit could create BIG expenses.

Medicare plans offered through private insurance companies help cover services not covered by Original Medicare.
For example Medicare Supplement Insurance Plans cover some costs not covered in Parts A and B. These are also referred to as Medigap Plans because they fill in the gaps of original medicare.

Medicare Supplement Plans offer nationwide coverage and are available by state. You do not need referrals and can go anywhere that Medicare is accepted. Your PRIMARY insurance is Medicare and your secondary is the Supplement. Depending which Supplement Plan you choose will determine the coverage and monthly premiums. They are all Standardized Plans ranging from the letters A-N. The F plan being the MOST comprehensive.

Most people with these types of plans will add a stand alone Part D so that they are covered for Parts A B and D...hospital, doctors, and prescriptions.
Then there is the Medicare Advantage (Part C) option: These plans are operated by private insurance companies approved by Medicare. You must have both Parts A and B to enroll. These plans cover all the benefits of Parts A and B, but may also include prescription drug coverage and benefits like Vision, Hearing, Dental, and Preventative services. Many plans have low or $0 monthly premiums plus copays or coinsurance only for the benefits you use. There are four main types of Medicare Advantage Plans.

1. HMO- Health Maintenance Organization Plans.
A Medicare Advantage HMO comes with a network of physicians, hospitals and other health care professionals. You must get all routine care from one of the plan providers. Your primary care physican oversees your care and may refer you to specialists.

2. POS- Point of Service Plans.
This is a type of HMO plan that provides care through a network of local doctors and hospitals, but lets you receive certain services outside the plan's network, generally at a higher cost.

3. PPO- Preferred Provider Organization Plans.
A Medicare Advantage Preferred Provider Organization (PPO) plan provides care through a network of physicians, hospitals and other health care professionals. You do not need a referral to see a specialist, and you can go out of network for any covered services, generally at a higher cost.

4. PFFS- Private Fee For Service Plans.
A Medicare Advantage Private Fee For Service plan is a non-network plan. You can receive care from any doctor or hospital that accepts the plan's payment terms and conditions.

In all types of Medicare plans, if you have an emergency or need urgent care, you can go to the nearest doctor or hospital.
Coverage varies by plan. Not all plans are available in every state or county.

If you join a Medicare Advantage Plan, you must continue to pay your monthly Part B premium. Costs vary by plan, but all Medicare Advantage Plans offer an ANNUAL OUT OF POCKET MAXIMUM so you can budget for health care expenses and limit your out of pocket costs each year.

Let us HELP YOU FIND a Plan that WORKS for you! Call today! (602) 882-2587.
For additional resources contact:

Medicare 1-800-633-4227 24 hours a day, 7 days a week
or go to www.medicare.gov

Social Security Administration 1-800-325-0778

Adminstration on Aging 1-800-677-1116