Family Medicare is the federal health insurance program primarily for Americans age 65 and over. It also covers younger residents with certain disabilities and diseases.
Family Medicare has different parts. Medicare Part A covers inpatient (hospital) care; Medicare Part B covers outpatient (physician) care. Together, they make up Original Medicare. edicare Part C is an alternative to Original Medicare. It’s more commonly referred to as Medicare Advantage. Participants get all the same Medicare benefits as Part A and Part B, but coverage is provided by private health insurers approved by the program. Medicare Part D is prescription drug coverage.
At Shelton Insurance, we offer Medicare insurance plans for families and seniors. Our licensed family Medicare insurance agents are ready to help you decide which plan makes sense for your needs and budget, and will review your coverage annual so you receive up-to-the-minute savings.
Most people get Medicare Part A premium-free, but are responsible for paying a deductible each benefit period. Benefit periods begin every time you’re admitted to a hospital and end when you’ve been out for 60 days. Copayments vary, depending on the amount of time you’ve spent in the hospital, but they end after 150 days. Everyone pays a premium for Medicare Part B and the amount varies depending on income. The cost of Medicare Advantage and Medicare Part D varies by plan.
Medicare Advantage health plans (such as HMOs and PPOs) are legally required to offer at least the same benefits as Original Medicare, but can include additional coverage as well, such as routine vision or dental benefits, health wellness programs, or prescription drugs.
Health Maintenance Organization (HMO) plans: These plans offer a network of doctors and hospitals that members are generally required to use to be covered. Because of this, HMOs tend to have strict guidelines, meaning that any visits and prescriptions are subject to the plan approval. If you use providers outside of the plan network, you may need to pay the full cost out of pocket (with the exception of emergency or urgent care). You generally need to get a referral from your primary care doctor to see a specialist.
Medicare Advantage Preferred Provider Organization (PPO) plans offer a network of doctors and hospitals for beneficiaries to choose from. Unlike an HMO, you have the option to receive care from health-care providers outside of the plan’s network, but you’ll pay higher out-of-pocket costs. Medicare Advantage PPOs don’t require you to have a primary care doctor, and you don’t need referrals for specialist care.
Special Needs Plans (SNPs): These plans limit enrollment to beneficiaries who have certain chronic conditions, are institutionalized, or qualify for both Medicare and state Medicaid (also known as dual eligibles). Benefits, provider options, and prescription drugs are tailored to meet the needs of the plan’s enrollees.
If you’d like to learn more about family Medicare plan options or if you’d like help finding coverage that may fit your needs, we’re here to listen to your questions and help you get answers. Sometimes talking over the phone is easier. Call us at (831) 637-8941.