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Health Insurance is insurance that pays if the insured is sick or injured. Health Insurance is heavily regulated by State and Federal laws.

Health Insurance does not dental work or eyeglasses or hearing aids. Health insurance requires the insured to pay the monthly premiums and if the monthly premiums are not paid the policy terminates after two months and can only be reinstated during annual enrollment period. Every health insurance policy has deductibles and co-pays. A deductible is the amount of money that must be paid for a service or services and then when it is met the insurance is started. The insurance company will then only pay a portion of the insurance and the insured must pay the other portion; this is called the co-pay. There is also a maximum out of pocket, which is the maximum amount of money an insured has to pay and then all services are free. Some policies include the deductible, and some do not. Most health insurance policies are purchased through an employer and is known as group health insurance.

Senior Health or Medicare Insurance

Medicare is a Federal Insurance program for people who are at least 65 years of age or with certain disabilities. Medicare Insurance is made up of Parts, Part A, Part B, Part C and Part D. Part A is hospital insurance, Part B is medical insurance, Part D is prescription drug insurance administered by private insurance companies and Part C is a combination of Part A, Part B and Part D administered by private insurance companies. People are eligible for Medicare if they have worked in the United States for 40 quarters and paid Medicare Tax during those quarters. Medicare is not free: Part A has a per occurrence deductible, Part B has a premium, an annual deductible and co-insurance.

Medicare Part C Insurance or Medicare Advantage

Medicare Part C can have premiums, deductibles, co-pays, co-insurance, in and out of network benefits and a maximum out of pocket. Medicare Part C can also include ancillary benefits such as dental, podiatry, vision and hearing/hearing aid insurance for little or no additional premium. Medicare Part C insurance can be an HMO plan where the Medicare beneficiary must see a doctor that not only contracts with Medicare but also with the private insurance company administering the plan. If a Medicare Beneficiary goes outside the plan network of doctors all costs will have to be paid by the beneficiary. Part C plans can be PPOs where the Medicare beneficiary can see doctor that contracts with Medicare or doctor that contracts with Medicare and the insurance company. The out-of-pocket rates vary depending on which doctor the beneficiary sees. There are other types of Part C plans, but most people choose HMOs and PPOs. Part C or Advantage plans can only be changed once a year or under particular circumstances.

Medicare Supplement or Gap Plans

To cover the costs that Medicare Part A and Part B does not cover, private insurance companies offer Supplemental or Gap insurance for an additional premium. There are different types of Supplemental Plan which cover different costs of Medicare. If you were eligible for Medicare Prior to January 2020 you can choose any Supplemental or Gap Plan. Anyone who became eligible for Medicare on or after January 2020 then there are only 3 plans that are available. Supplemental or Gap Plans can be changed once a month as long as the Medicare Beneficiary can be medically underwritten. Some states offer the ability to change plans without medical underwriting either all year round or certain times during the year.

Prescription Drug Plan – Part D

Part D prescription drug insurance offers insurance on certain medications (formulary) (lower or no cost) in return for you paying a premium, deductibles, co-pays and co-insurance. Depending on the set of medications taken by the Medicare Beneficiary a particular plan by a particular insurance may be better than others. Prescription Drug Plan can only be changed once a year or under particular circumstances.


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