Ashford Insurance is an Independent Marketing Organization working with United HealthCare Medicare Solutions.
Medicare Insurance Made Easy
Welcome! We Know Medicare is Confusing! Let Us Help! Ashford Insurance is an independent insurance agency specializing in the Medicare market. As an independent agency, we have the freedom to offer any Supplement or Medicare Prescription Drug product from any company. After reviewing all your doctors and prescriptions, we can give you a true and unbiased opinion.
Medicare is split into three basic parts: Parts A, B, and D. Part A is hospital insurance while Part B is medical insurance and Part D is prescription drug coverage. There are two other options as well: Medicare Advantage, originally called Part C and designed as an alternative to Parts A and B, and Medigap, a supplement to Parts A and B that fills in gaps in insurance and is sold by private insurance companies.
Medicare doesn’t cover elective procedures such as cosmetic surgery, and there’s a deductible for each hospital stay or other covered service. As such, most members will have out-of-pocket costs even in cases where all services are medically necessary and covered by Medicare.
Medicare Part A
Medicare Part A is also referred to as hospital insurance. It covers inpatient care in hospitals and skilled nursing facilities, but it doesn’t provide coverage for custodial or long-term care in most cases. Some in-home health care and hospice services are also covered, depending on specific eligibility criteria.
Most Americans enrolled in Medicare Part A have paid for this coverage via payroll tax collected during their working years, or they receive coverage based on the payroll tax paid by a spouse. In some cases, the enrollee pays a monthly premium for Part A coverage.
Coverage is based on federal and state laws as well as national and local decisions that relate to whether the requested services and items are medically necessary.
Medicare Part A covers:
- Inpatient hospital care
- Acute care (long-term care hospital costs)
- Skilled nursing facility care
- Nursing home care (not custodial or long-term care)
- Hospice care
- Home health care (physical and occupational therapies, speech-language pathology, medical social services, part-time or intermittent skilled nursing and home health aide services)
Eligibility for Part A
Enrollees must be aged 65 or older, disabled, or diagnosed with end-stage renal disease (ESRD), which is the fifth and final stage of chronic kidney disease. Those who are receiving Social Security or Railroad Retirement Board benefits upon turning age 65 are automatically enrolled in Medicare Part A with no premium attached.
Medicare Part B
Medicare Part B is also referred to as medical insurance. It covers some of the enrollee’s outpatient costs and doctor bills, but in most cases, it doesn’t fully cover any of the applicable goods and services.
In the case of preventive care, however, Part B covers the full cost of services rendered by providers that accept assignment (i.e., the provider is paid an approved amount directly by Medicare.)
Medicare Part B covers:
- Services and supplies required for diagnosis and treatment of medical conditions (primary care physician, surgeons, emergency room care, etc.)
- Preventive services
- Ambulance services
- Durable medical equipment (DME)
- Clinical research
- Some outpatient prescription drugs
- Mental health services (inpatient, outpatient and partial hospitalization)
Eligibility for Part B
Medicare Part B eligibility is dependent on the enrollee’s eligibility for Part A and whether they pay a premium for it. Those who are enrolled in or eligible for Part A with no premium can enroll in Part B without further requirements, although they must sign up during Medicare’s defined enrollment periods. Those who do pay a premium for Part A must be aged 65 or older, a U.S. resident and a citizen or lawfully admitted alien residing in the United States for at least 5 years.
Medicare Part D
Medicare Part D is also referred to as prescription drug coverage. The majority of those enrolled in Part D pay a premium.
Although the federal government maintains authority and oversight over Part D, the plans are offered by private insurance companies that are responsible for setting the rules of coverage. For example, plans differ on which drugs are covered and whether coverage is for a brand name or generic drug.
Additionally, the list of covered prescription drugs in each plan is not set in stone. Members of a Part D plan are allowed to view any upcoming changes to covered drugs each year, and they may wish to change plans and providers if they’re negatively affected by these changes.
Medicare Part D Covers:
- Selected prescription drugs (list differs by plan)
- Drugs may be brand name or generic
Eligibility for Part D
Part D is available to anyone enrolled in Original Medicare or who has joined a Medicare-approved plan with prescription drug coverage listed as a benefit.
Medicare Advantage and Medigap
Coverage by Part C is a replacement for both Parts A and B (Original Medicare), and it’s usually less expensive for the member. The potentially lower costs are balanced by the added complexities of Part C coverage.
Members of a Medicare Advantage Plan must be provided with the same coverage as Parts A and B, at a minimum, but there may be additional rules in place. For example, services may be limited to particular settings, and the rules for coverage may be different based on the member’s health conditions. As these plans are offered by private insurance companies, they can differ based on location and may not be accepting new members at any given time.
Medigap is also referred to as Medicare Supplement coverage. As the name suggests, this type of coverage is intended to fill the gaps in, or be a supplement to, Original Medicare (Parts A and B). Federal and state regulations set the framework for Medigap plans, but they’re sold by private insurance companies.
One of the requirements is that plans are standardized across all insurance providers in a particular state, which makes it much easier to compare costs. Medigap plans don’t provide prescription drug coverage like Part D as they did before 2006, and they can’t be used if you’re enrolled in Medicare Advantage.
Our goal here at Ashford Insurance is to ensure you understand your options in the Medicare marketplace. We know that this can be a very tedious endeavor and every individual is different; having access to major carriers is the only way to determine what level of coverage will best suit your needs.
Need help? Call us for an appointment at (817) 952-3153
Ashford Insurance Agents
Here is a partial list of the products offered by Ashford Insurance
* A licensed sales agent may call or e-mail as a result of completing the information to discuss Medicare Advantage, Prescription Drug Plans or Medicare Supplement Insurance.
Recent Blog Articles
Last week, the Centers for Medicare & Medicaid Services (CMS) released the 2022 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs, and the 2022 Medicare Part D income-related monthly adjustment amounts.
It seems that nothing ever changes when it comes to hawking insurance to fill the gaps in Medicare coverage for seniors. The fervent sales pitches, the misinformation and the incomplete and deceptive information continue to proliferate. The problems are especially prevalent during Medicare’s open-enrollment period, which began Oct. 15 and runs through Dec. 7.