Medicare is basically a federal health insurance program that includes the services such as lab tests, surgeries, doctor visits and medically necessary supplies, such as walkers and wheelchairs. Medicare plan is for those people who are 65 or older. Younger people are also included if they have certain disabilities, and people with End-Stage Renal Disease also called as ESRD, who have permanent kidney failure requiring dialysis or a kidney transplant.
Medicare plan has generally two parts that have different features like Medicare Part A and Medicare part B. In general, Part A covers the services such as home health services, hospital care, nursing home care and skilled nursing facility care. While in general, Part B covers two types of services. First includes medically necessary supplies or services that are needed to diagnose or treat a medical condition, while second includes preventative services, or health care in order to prevent different illnesses. It also covers things like clinical research, mental health treatment, ambulance services, durable medical equipment, limited outpatient prescription drugs and second opinions before a surgery.
The above mentioned features are related to Medicare plan. There is another plan of Azmedicare i.e. Medicare Advantage plan. This plan is available for Arizona residents only. This plan includes a series of Healthcare Plans. These plans are created in partnership between Medicare and Private Insurance companies. They provide cost effective healthcare services to those beneficiaries who are medicare eligible. Medicare advantage plans and Prescription Drug Plan sponsors must have a contract with Medicare in order to sell Medicare insurance plans (such as a Medicare HMO or a Medicare Part D Prescription Drug Plan.
Medicare Advantage plans, also referred to as Medicare Part C plans or MA plans. Approved private health insurance organizations manage and administer these plans. Participants who are selected to receive Medicare benefits through a Medicare Advantage provider must receive all Medicare benefits (including optional Part B and Part D plans) through the provider. Every plan is not accessible in all states or in all service areas but it depends on the terms of the contract between the plan and Medicare. The plan must renew their contract with Medicare every year, so that the availability of a plan in a specific service area is subject to change as a result of the annual contract renewal.
There are five types of plans available in Arizona:
Preferred Provider Organization (PPO) is a managed care plan in which you use hospitals, doctors and providers that belong to the network. People do not need a referral from a primary care physician to go to a specialist. For an additional cost, people can receive services outside of the network.
Health Maintenance Organization (HMO) includes a group of hospitals, doctors and other health care providers who agree to give health care to Medicare beneficiaries for a set amount of money from Medicare each month. In an HMO, people need a referral from a primary care physician to go to specialists and usually get all their care from the providers that are part of the plan.
Medicare Savings Account (MSA)
This type of health plan has two parts:
- First part includes special type of savings account used for health related expenses only. Medicare deposits a set amount per year into customer’s account and the money can remain in the account if customer does not use it by the end of the year.
- High deductible health plan (minimum of $2000): With this type of plan, Medicare pays the premium for the MSA plan and makes a deposit into the MSA established by the beneficiary. The money in the MSA can be used to pay for health services provided before the deductible is met and for services not covered by the MSA plan. After the deductible is met in a given year, Medicare-covered services are covered by the health plan.
Private Fee for Service (PFFS) is a private insurance plan that accepts Medicare beneficiaries. People may go to any doctor or hospital they want. Rather than the Medicare program, the insurance plan decides how much people pay for the services they get. They may have extra benefits the Original Medicare Plan does not cover. They may pay more for Medicare covered benefits.
Special Needs Plan (SNP) is an HMO type plan but it provides membership to only to those people who are eligible for both Medicaid and Medicare or who have chronic disabling conditions or who reside in certain long term care facilities. Special needs plan is designed in such a way that provides medicare health care and services to those people who want benefits from things the most like focus on the care management and special expertise of the plan’s providers.
There is another plan i.e. Medigap which is also known as medicare supplements. It is a health insurance policy sold by few private insurance companies in order to fill the gap in the original or basic medicare plan coverage. Medigap policy covers all the features that are even not included in original basic medicare plan and it helps to pay some of the health care costs. If any customer is registered in the original medicare plan and have medigap policy as well then later will pay both shares of covered health care costs. If you are in the Original Medicare Plan and have a Medigap policy, then Medicare and your Medigap policy will pay both their shares of covered health care costs. 80% of the medical bills are paid by medicare while the remaining 20% is paid by medigap or medicare supplements.
Customers don’t need to pay any bills if they get plan F Medicare supplement because medicare pays its part and the supplement pays the rest. Cost varies in all Medigap policies while the benefits in plan A through N are same for all insurance companies.
Azmedicare provides the best services and best rates for Arizona residents. It represents the top insurance companies of the state. It has many plans and all are at affordable prices. Many has zero monthly premiums. Azmedicare empowers customers to take charge of their health.