Find a Medicare Plan in Louisiana
WHAT IS MEDICARE?
Medicare is a service funded by the U.S. government, ensuring that seniors have access to quality healthcare and needed services. The Department of Health and Human Services oversees the program. While Medicare may seem daunting, the licensed insurance agents at The Fussell Group Insurance Advisors are ready to guide you through all your important insurance decisions. Whether you pick a Medicare Advantage plan or Medicare Supplement Insurance Plan, we are here for you.
Medicare is a federal health insurance program available to individuals 65 and older. It is also available to those with certain health conditions or disabilities and end-stage renal disease or ALS. The Centers of Medicare and Medicaid oversee the program. There are four parts to Medicare- Part A, B, C and D.
Medicare Part A and B are considered Original Medicare. Medicare Part A is Hospital coverage. Most people are automatically entitled based on Medicare taxes paid by you or your spouse during working years. If you do not qualify for Premium Free Part A, you will be responsible for a monthly premium.
Medicare Part B is Medical coverage. It covers medically necessary doctor’s services, outpatient care, durable medical equipment, preventative services, a limited number of outpatient prescription drugs like injections in a physician’s office, certain oral cancer medications, and more.
Most people are automatically enrolled at age 65. An individual can decline part B coverage if he or she will have a continuation of employment or a spouse’s employment and credible insurance coverage is provided by the employer.
Someone can also enroll in Part B the month after he or she has been on Social Security Disability for 24 months. For Part B, you pay an annual deductible plus 20% of Medicare approved costs.
Medicare Advantage in Louisiana
What Are Medicare Advantage Plans?
Medicare Advantage plans are also known as Medicare Part C and provide various levels of coverage for beneficiaries. They are sold by insurance companies and not directly through Medicare. Medicare Advantage plans provide Part A and Part B coverage combined. Through this option, Original Medicare will not be billed for your medical services, but the beneficiary will still be billed for the Part B premium.
Part C is also known as a Medicare Advantage Plan. Medicare Advantage Plans must cover all parts of Original Medicare A & B. In addition, they may cover Part D Prescription Drug coverage, fitness programs, emergency medicare care outside of the U.S., dental, vision and hearing services. In addition, Medicare Advantage Plans also tailor their benefit packages to offer additional benefits to certain chronically ill enrollees. Medicare pays a fixed amount each month to the companies offering Medicare Advantage Plans. These companies must follow the rules set by Medicare.
Types of Medicare Advantage Plans
There are different types of Medicare Advantage plans, which bill differently and cover varying services.
Health Maintenance Organization (HMO) Plans typically require services to be rendered by their list of approved doctors. However, some exceptions can be made in emergencies. In most cases, these plans offer prescription drug coverage.
Preferred Provider Organization (PPO) plans also have a list of doctors who are approved. You will have a smaller bill if you choose to go to one of these doctors and will be billed more if you choose healthcare outside of the predetermined network. In most cases, these plans offer prescription drug coverage.
Private Fee-for-Service plans have predetermined amounts you’ll pay for each procedure or appointment.
Special Needs Plans are reserved for qualifying individuals with certain health situations. Medicare and Medicaid are Dual Eligible Special Needs Plans. These certain situations offer reduced or eliminated costs for the enrollee. All Special Needs Plans must provide prescription drug coverage.
Medicare Prescription Drug Coverage
Some Medicare Advantage Plans (Part C) offer prescription drug coverage. You generally get all of your Medicare Part A (Hospital Insurance), Medicare Part B (Medical Insurance), and Part D (Drug Coverage) through these plans. Medicare Advantage Plans that offer prescription drug coverage are sometimes called “MA-PD’s.”
Medicare Part D is Prescription Drug Coverage. This is only offered by Private Insurance Companies to help pay for prescription drugs. You must be entitled to Part A and/or enrolled in Part B to receive this coverage. To obtain Medicare Drug Coverage, you must join a Medicare approved plan that offers drug coverage. Such as a stand-alone Prescription Drug Plan or a Medicare Advantage Plan. If you do not enroll when you are first eligible, you do not have creditable coverage or extra-help, you may have to pay a late enrollment penalty.
MEDICARE SUPPLEMENT INSURANCE
The Importance of Medicare Supplement Insurance
Some may find that Medicare covers all of their health costs. Others need services that aren’t covered by Medicare and will be paying out of pocket, which can become costly. For those who need help paying for costs not covered by Original Medicare, a Medicare Supplement Insurance Plan (Medigap) may be a good option. Medicare Supplement Insurance plans are an alternative to a Medicare Advantage plan, and you cannot have both at the same time.
Medigap (Supplement)
Medigap is sold by private insurance companies to fill in the gaps or “supplement” the out-of-pocket costs of Original Medicare. It is an excellent option for many that are looking to expand their coverage while still using Medicare. Most Medigap plans allow the consumer freedom to choose their own doctor or hospital without the limitations of a network.
They also cover the consumer anywhere they travel in the U.S. These plans have a monthly premium in addition to your monthly Medicare Part B premium. These premiums are set annually and will increase based on age. With a Medigap plan, Medicare Prescription Drug Coverage must be purchased separately. If you do not purchase a Medigap plan in open enrollment, you will be subjected to health questions (underwriting).
Medigap Plans
Just like Medicare, Medigap plans are assigned letters. Medigap Plans are A, B, D, G, K-N and cover varying percentages of different costs. Some plans pay deductibles, while others cover travel or blood transfusions.
Choosing a Medigap Plan
When deciding which Medigap plan to purchase, there are many things you should take into account. What your Original Medicare covers, what costs you’ve had to pay in the past, and what costs you’re expecting in the future should all be thought about.
The best way to ensure you’re getting the right Medigap plan is to work with an insurance agent. Call the Fussell Group and let one of our licensed insurance agents in your area assist you.
FAQs about Medicare
What is Medicare?
Medicare is a federal health insurance program available to individuals 65 and older. It is also available to those with certain health conditions or disabilities and end-stage renal disease or ALS.
Who is Medicare for?
Medicare is for those Turning 65, 65 or older and retiring from Group Coverage, on Disability for 24 months, or diagnosed with ESRD or ALS.
How do I get approved for Medicare?
If you are Turning 65, 65 or older and retiring from Group Coverage, on Disability for 24 months, or diagnosed with ESRD or ALS.
How much is Medicare?
Currently, the 2024 cost for Medicare Part B is $174.70. The yearly Part B deductible is $240.
Will my plan pay for an assisted living facility/nursing home?
No, it will not. It will however offer you prescription drug coverage through your current Medicare plan to help pay for your medications.
What is the difference between a Medicare Supplement and Medigap?
It is the same.
What will be my premium for Medicare Part A?
If you and or your spouse have paid Medicare taxes while working, you will have a premium free Part A. If you are not eligible for premium free Part A, you will pay $278 or up to $505 each month depending how long you and or your spouse paid Medicare taxes.
If I miss the Annual Enrollment Period, is there another time during the year that I can change plans if I am unhappy with my current Medicare Advantage Plan?
Yes. Open Enrollment Period (January 1-March 31), a Five Star Medicare Health Plan, or a Special Election Period.
When can I join, switch, drop, or make changes to my Medicare Advantage Plan?
You may first join during your Initial Enrollment Period when you become eligible for Medicare. This period is three months before your birthday, the month of, and three months after. Your policy will be effective the first day of the month you were born, or the first of the month you choose to enroll after your birth month (remember, you only have three months after your birth month to enroll initially). You also have the General Enrollment Period (January 1-March 31st) to enroll in a Medicare Advantage Plan if you have Part A coverage and get Part B for the first time during this period. Your coverage starts the first day of the month after you sign up. Lastly, you can use the Annual Enrollment Period (October 15-December 7) to join, switch, or drop a Medicare Advantage Plan with coverage beginning January 1st.