June 14, 2023
In July 1965, President Lyndon B. Johnson signed the Social Security Amendments of 1965 into law, creating the Medicare and Medicaid programs. For the first time, individuals over the age of 65 would be eligible for health insurance, regardless of their income, medical history, or employment status. Since its inception nearly 60 years ago, Medicare has undergone substantial changes and improvements. It continues to play a significant role in the United States healthcare system, providing healthcare coverage to about 20% of the population, including retirees and disabled individuals. While hospital and medical services insurance are the backbone of Medicare, through additions such as health maintenance organizations (HMOs) and prescription drug coverage, Medicare now has more to offer eligible individuals than ever before.
What coverage does Medicare provide?
Original – or traditional – Medicare provides benefits to individuals through Part A Hospital Insurance and Part B Medicare Services Insurance to cover services for beneficiaries as both an outpatient and inpatient. Part A covers inpatient hospital stays when a beneficiary has been admitted to the hospital, while Part B medical insurance helps pay for services and products not covered by Part A, generally on an outpatient basis. However, there are instances that Part B coverage may apply to acute care settings, such as for physician-designated observation status at a hospital.
While the services provided by Original Medicare generally have no upper dollar cap when paying for covered services, there are financial responsibilities and out-of-pocket costs for the enrollee. Medicare beneficiaries are responsible for premiums, deductibles, copayments, coinsurance, and other costs. In 2023, the Medicare Part B premium costs are $164.90 per month, with Part A at $0.00 for most enrollees.
While Medicare Parts A and B provide a broad scope of coverage across the healthcare spectrum at a relatively low cost, it is not all-inclusive, leaving out some vital aspects of care, such as vision, hearing, and dental.
The added perks of a Medicare Advantage plan
Medicare Part C, known initially as the Medicare+Choice program, was created in 1997 by the Balanced Budget Act. In 2003, the program was renamed and revitalized, officially becoming Medicare Advantage. As beneficiaries continue looking for more affordable or flexible plans, Medicare Advantage plans have become increasingly more popular, with options to combine the coverage of Parts A and B with other coverage options, such as prescription drug coverage for an added premium.
No two Medicare Advantage plans are the same, with variety even among the plans from individual carriers. Over the past few years, several benefits have increased in popularity among Medicare Advantage plans, helping to provide Medicare beneficiaries with the most comprehensive coverage. Additional coverage options include vision, hearing, and dental coverage, as well as fitness and over-the-counter benefits. While each plan will offer different variations on the coverage options, examples of coverage could include:
Vision coverage: One Annual Routine Vision exam per plan year with cost-sharing options for medically necessary vision aids such as glasses or contacts.
Hearing coverage: One Annual Routine Hearing exam per plan year with cost-sharing options for medically necessary hearing aids.
Dental coverage: Bi-annual periodic oral evaluations and x-rays with additional cost-sharing options for medically-necessary dental procedures and interventions, including fillings, extractions, and periodontal cleanings.
Fitness benefits: Reimbursement allowances for health club memberships, nutritional counseling, or weight management programs.
Over-the-counter benefits: Reimbursement allowances to spend on Medicare-approved health-related items.
The advantage of a Medicare Advantage plan: let us help!
Medicare can be complicated, and making an informed decision about coverage is important. Speaking with a licensed insurance agent can help mitigate confusion that may arise during a critical decision-making period.
Contact Aevo Insurance Services, a division of Brown & Brown Absence Services Group, to speak with an agent about your Medicare options, including Medicare Advantage plan options. Our guidance extends through every step of the enrollment process, starting with helping select a Medicare plan that meets your unique medical and financial needs.
Nothing herein is considered legal advice. Nothing in this post is intended as advice or a suggestion to elect or not elect to claim benefits of any kind, including Social Security benefits, nor is it intended as financial advice in any way. The decision to claim benefits is a personal one that is contingent upon each individual’s unique circumstances.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all your options.
Please note that as of 2021, The Advocator Group now conducts business as Brown & Brown Absence Services Group. While our name may have changed, our commitment to excellent service and helping our clients in as many ways as possible has not.