Medicare Benefits

Medicare benefits are provided by the federal government. The good news is that they pay for the majority (but not all) of most senior’s medical bills.

Unfortunately, the not so good news is that Medicare benefits typically do not cover about 20% of senior’s medical bills; and with medical expenses frequently running into thousands and hundreds of thousands of dollars, uncovered expenses can be a very big number. In addition, Medicare does not cover most home care and long-term care expenses.

Fortunately, in addition to Medicare, there are several low-cost and possibly no-cost government funded healthcare insurance options. ACCESSMed’s mission is to help low income seniors understand and enroll in them.

Original Medicare Benefits

Original Medicare is made up of two parts: Medicare Part A covers hospital insurance, and Medicare Part B covers medical expenses such as doctor visits, lab work and some medical equipment.

Original Medicare typically covers about 80% of Part A and Part B expenses. Patients are responsible for the remainder of their medical expenses, including prescriptions.

Individuals who select Original Medicare should consider selecting an additional private insurance plan (such as a Medigap, Medicare Advantage or Prescription Drug plan) to cover expenses that Original Medicare does not cover.

Read more about Original Medicare.

Medicare Medigap
Supplement Insurance

Medigap supplement insurance helps to fill the gaps in Original Medicare coverage. It is provided by private insurance companies. Medigap policies frequently cover co-payments, deductibles, and health care expenses incurred outside the U.S. However, Medigap coverage does not extend to long-term care, vision or dental care, hearing aids or prescription drugs.

Read more about Medicare Medigap insurance.

Medicare Advantage Insurance

Many seniors enjoy extensive additional Medicare benefits through a Medicare Advantage plan. Medicare Advantage provides Medicare Part A and Part B benefits through a private, Medicare-approved insurance company. Many plans provide extensive additional benefits possibly including prescription drug coverage, routine vision and dental care, over the counter health products and equipment, meals and transportation to health care appointments. The most common plan types are HMO and PPO.

• An HMO, or Health Maintenance Organization is a group of doctors, hospitals, and other health care providers who agree to provide Medicare benefits to beneficiaries for a fee that the government pays them. In an HMO, you usually must get all your care from the providers that are part of the plan and you need a referral from a primary care physician to go to specialists.

• A PPO, or Preferred Provider Organization is a managed care plan that provides Medicare benefits through doctors, hospitals and other providers that belong to a network. You have the option of receiving services from providers outside the network at additional cost. You do not need a referral from a primary care physician to go to a specialist.

Both HMO and PPO plans generally include prescription drug coverage through a Medicare Advantage Prescription Drug Plan (MAPD). In addition, it may be possible to have both Medicare Advantage and Medicaid insurance Medicare benefits at the same time.

Read more about Medicare Advantage.

Dual Special Needs Medicaid

In Arizona, Dual Special Needs coverage combines AHCCCS Medicaid with Medicare Advantage coverage to provide seniors and other individuals with limited incomes and limited financial resources with low-cost and possibly no-cost healthcare coverage.

Qualified individuals can sign up for a Medicare Advantage plan when they enroll in AHCCCS Medicaid. This dual coverage is referred to as a Special Needs Plan and several types of Special Needs Plans are available.

Read more about Dual Special Needs Plans.

Medicare Part D Benefits

Medicare Part D coverage helps pay for prescription drugs. This insurance is optional. It is very important to be aware, however, that if you decide not to enroll in a Part D plan when you are first eligible, and you don’t have other creditable prescription drug coverage (like drug coverage from an employer or union) or get Extra Help, then you will likely pay a late enrollment penalty if you join a plan later. And, you will pay this very substantial penalty for so long as you continue to have Part D coverage.

To get Medicare Part D coverage, you must join a Medicare-approved insurance plan that offers drug coverage. There are two types of Part D drug coverage:

1. Medicare drug plans.
2. Medicare Advantage Plans or other Medicare health plans that include drug coverage.

Read more about Medicare Part D benefits.