Medicare offers comprehensive health insurance and medical care. Original Medicare uses Part B for a range of physical and mental health services, prevention, and wellness. It offers tests and screening, checkups, and vaccines.
Many services come at no extra cost to the participating members. The below-listed sections are the major parts of Medicare.
Medicare Part A – Hospital insurance that covers medical care deemed reasonably necessary to treat an illness or disease. It includes equipment and hospital stays
Medicare Part B – Medical insurance for older Americans. It covers medical services from doctors, hospitals, and other medical care providers.
Medicare Part C – Also known as “Medicare Advantage.” This program combines the hospital and medical coverage of Parts A and B and adds private insurance features.
Medicare Advantage – Adds benefits not found in Original Medicare; it increases benefits and, in some cases, reduces costs.
Original Medicare – The standard for medical care for older Americans. It is a comprehensive system that treats applicants as evenly as possible. It is a one-size fit all approach to managed care.
Medicare Supplement – This is private insurance to complement original Medicare. Original Medicare pays up to 80 percent of agreed amounts leaving 20 percent for the consumer. Medigap pays part of the consumer share depending on the type of charges.
Medicare B Coverage
Medicare Part B covers preventive services like vaccines and screenings. Part B has many prevention and early detection services that go without additional charge to Original Medicare holders.It covers medical services outpatient and hospital services.
It also provides medically necessary services. This means the equipment and health services needed to diagnose or treat a disease or illness, including mental illnesses.
The services and determinations must meet or exceed accepted standards of medical practice. Part B includes the below-listed services when deemed medically necessary.
Outpatient prescription drugs
Second opinion before surgery
Durable medical equipment
Medicare Advantage Offers Variety
Medicare Advantage plans approved by the Centers for Medicare and Medicaid meet the requirement of the individual mandate and avoids the tax penalty for unqualified insurance. When selecting among Medicare Advantage plans, consumers can use comparison shopping to focus on the features that matter most to them.
There is great flexibility in Original Medicare to pick and choose doctors and medical care facilities.
HMO and PPO managed care require or prefer network resources over outside resources. Medicare Advantage offers the below-listed types of managed care.
HMO is the health management organization; it uses a primary care physician to make referrals. The HMO uses network resources.
PPO is the preferred provider organization; it permits patients to see doctors without referrals. It covers outside resources but patients pay more than when using network resources.
EPO represents the exclusive provider organization. This is usually a small network designed to keep prices low. The EPO does not use outside resources and does not pay when patients go outside of the network.
HMOPOS is a variation on the HMO that gives consumers more choices. The HMOPOS uses a primary care physician, and he or she makes referrals. The POS approach permits referrals to outside resources with insurance coverage. Patients pay more when using referrals to outside resources.
PFFS describes the private fee-for-services approach to managed care. These networks consist of doctors and medical care providers that accept particular terms for their services. These negotiated agreements help hold down prices for consumers.
The Individual Mandate
Part B does not meet the requirements of the individual mandate. Part A meets the mandate and Parts A and B together satisfy the mandate and form a powerful combination of hospital and medical insurance coverage.
Those with Original Medicare meet the Affordable Care Act and avoid the tax penalty.
Part D and Medicare Supplement have no effect on the mandate, and these programs do not help avoid the penalty.
Part B Does not Standalone
Part B does not avoid the penalty for qualified health insurance coverage. By itself, it lacks essential protections. Similarly, Part D Prescription Drugs provides private insurance plans for insuring the costs of prescriptions. Part D depends on the consumer also enrolling in Parts A, and B.
Some Medicare Advantage and Medigap plans offer this option. One can have but one prescription drug plan. Medicare will adjust those with two prescription plans, such as from Medicare Part D and Medicare Advantage, and return the policyholder to Original Medicare.
Part B Late Enrollment
The best time to buy Part B coverage is during the initial enrollment period. Buyer’s purchasing Part B after the initial enrollment may have to pay a late fee.
The government determines the late fee based on the number of months that pass between eligibility and purchase. The Centers for Medicare and Medicaid applies the Medicare Part B late fee each month for the duration the coverage.
Prevention and Wellness
Wellness visits are a critical part of Part B prevention services. Wellness visits occur when the patient is symptom-free, and they set important baseline information. Wellness sets a course for continued well-being. It emphasizes diet, exercise, and weight control, and healthy habits.
Wellness visits are particularly important for women, women of childbearing age, and women about to become pregnant. Strong prenatal care begins with a healthy mother-to-be.
Tobacco cessation and counseling programs are important long-term benefits for Medicare beneficiaries. Both for individual lives and the health of the overall US population, smoking cessation is a key.
Tobacco usage causes an enormous amount of human suffering from diseases brought on or exacerbated by smoking, second-hand smoke, and other forms of tobacco usage.
Part B Is an Important Benefit
Medical insurance is an essential part of comprehensive health insurance coverage. One must select Part B to get Original Medicare health insurance.
Medical insurance covers the services of doctors and medical care institutions. Medicare Advantage provided the same coverage as Original Medicare; it has the functions of Part B.
Comparison shopping is an excellent method for finding the best value among private insurance plans. Medicare Advantage performs the medical insurance functions of Medicare Part B.
There are many private plans to choose from and types of managed care such as HMO or PPO with options on network resources and expenses.