Learn the basics of Medicare, from terminology to eligibility.

Learn the basics of Medicare, from terminology to eligibility.

Original Medicare is offered by the federal government and includes Part A and Part B

Part A (Hospital care)

Part A covers inpatient hospital care. It is available at no additional monthly premium for most people, and you will pay a portion of the cost for the services and benefits you use.

Part B (Medical care)

It helps pay for doctor’s office visits, outpatient care, and a few other things. This has a monthly premium that is usually deducted directly from your Social Security check.

Medicare Part C and Part D refer to Medicare plans offered by private insurers.

Part C (Medicare Advantage)

Part C plans combine all the benefits of Part A and B with additional benefits, such as dental, vision, hearing, and gyms. Unlike Original Medicare, they have an out-of-pocket maximum, so you can budget for your health care costs. And many include Part D prescription drug coverage. Bright HealthCare Medicare Advantage plans are available from as low as $ 0 a month.

Part D (Prescription Drugs)

Part D plans help pay for prescription drugs. You can enroll in a Part D plan, or get your drug coverage with a Medicare Advantage plan that includes Part D. Not all plans are created equal, so the plan you choose must include the medications that have been prescribed for you.

Learn more about your Medicare options.

You can continue browsing the resources available on our site. However, if you prefer a more personal approach, consider attending one of our “New to Medicare” events or a community meeting.

The basics of Medicare eligibility.

To be eligible for Medicare, you must be a US citizen or a legal resident who has lived in the United States for at least five consecutive years. Most people are eligible for Medicare when they turn 65. Adults under 65 with certain disabilities or medical conditions may also be eligible for Medicare. You can use the eligibility calculator on Medicare.gov

 for full details on your eligibility, but be sure to come back here when you’re done to see the plans.

Commonly used terms about Medicare Advantage costs.

When comparing plans, the following cost terms will help you evaluate which plan fits your coverage and budget needs.

  • Copayment: After paying deductibles, the copayment is a fixed amount of money you pay for the cost of a health-related service (such as a provider visit) or a supply (such as a drug). The insurer pays the rest.
  • Out-of-pocket maximum: The highest amount you will pay for medical services or supplies before your insurer pays the rest.
  • Penalty: A charge that is added to your monthly premium if you do not enroll when you are first eligible; applies only to Part B or Part D.
  • Premium: A monthly fee that you can pay when you join a plan. Not all plans have a premium.

Maximum Lifetime Benefit: 

 This is the total amount that will be paid by ASSA for each insured person. During the entire term of the policy. As long as the Insured lives.

  • Coinsurance: it is how both, the Insured and the Insurer, share the cost of a claim, according to the percentage established in the policy. The most common are 80% the Insurer, 20% the Insured.
  • Preexisting Condition:  any symptom of ill health, illness, or injury suffered by the Insured with or without his knowledge, before contracting the policy.
  • Eligible Expenses:  refers to those expenses incurred that would be covered by the policy. Maximum annual out-of-pocket for coinsurance: it is the maximum amount per policy year or for cause, which an insured must incur in respect of his / her participation in the coinsurance.

Total Claimed: 

the total amount of medical expenses presented.

  • Deductible:  fixed amount agreed in your insurance policy in which before the Insurer issues any payment you must incur (as long as the expenses are considered eligible), this deductible is annual and cumulative and per insured or insured family member.
  • Non-Covered Expenses:  expenses expressly excluded in the Insurance policy. In this line, the excess of Usual Reasonable and Customary amounts (URA) also applies.
  • Basic:  100% coverage of eligible expenses according to the coverage of your policy. Medical expenses

As you explore your coverage options. You can also verify your eligibility for the Extra Help program. Which assists with paying for prescription drugs, premiums, deductibles, and more.

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