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Insurance and how it works

Insurance comes in many types.  The primary ones discussed here are Medicare, Medicaid, MedWaiver, Regular insurance, HMO's and PPO's

 

What is Medicare

 

Medicare is the federal health insurance program that covers most people age 65 and older. Some younger people who are disabled or other disabilities or diseases may also eligible for coverage.

Medicare pays for much of a covered persons health care expenses but not all. That is, Medicare covers most acute medical conditions – conditions from which a patient usually recovers.  However, Medicare does not cover most care given at home, in assisted living facilities or in nursing homes, for people with chronic disabilities and lengthy illnesses. And for many people, there are large gaps in Medicare's prescription drug plans.

Medicare provides four different levels of benefits :

1.    Part A helps pay for inpatient hospital care, some skilled nursing facilities, hospice care, and some home health care.Part A is premium free.

2.    Part B – the part that helps pay for doctors, outpatient hospital care, and some other care that Part A doesn't cover, such as physical and occupational therapy.  Beneficiaries  pay a fee or premium for this service.

3.    Part C allows various HMOs, PPOs and similar health care organizations to offer health insurance plans to Medicare beneficiaries. At a minimum, they must provide the same benefits that the Original Medicare Plan provides under Parts A and B. Part C organizations are also permitted to offer additional benefits such as dental and vision care. But, to control costs, Part C plans are allowed to limit a patient's choice of doctors, hospitals, etc., to just those who are members of their networks. This can be a major disadvantage if a patient's favorite doctor or hospital is not a member of their networks.

4.    Part D provides prescription drug benefits through various private insurance companies. For more information, including how to enroll, click on Medicare Prescription Drugs benefit. Like Part B, most people have to pay extra premiums each month to be covered for prescription drugs under Part D. Premiums for Part D vary from state-to-state, and from company-to-company. For more information, visit Medicare's website.

Most seniors are covered under the Original Medicare Plan. That plan requires them to pay for some of their health care in addition to their monthly Part B and Part D premiums. Those additional amounts are called deductibles and coinsurance. Beneficiaries are allowed to purchase other insurance policies to cover part or all of Medicare's deductibles and coinsurance amounts, or to cover many types of care that it doesn't cover.

 

Your Medicare benefits with AAA Medical

 

What is Medicaid/MedWaiver