Numerous senior citizens in the US do diligent financial planning and save money their entire lives for a comfortable retirement. But due to the rising healthcare costs and expensive medications, it’s not uncommon for people in the US to go through medical debt.
Several surveys reveal that approximately 16 million adults in the US are currently going through medical debt and owe more than $10,000. Medical debt isn’t limited to a certain demographic but equally affects everyone that is suffering from chronic ailments, especially those with disabilities.
Even after a lifetime of meticulous financial planning, nobody is safe from the financial strain that comes with medical emergencies; nearly 1 in 3 US families usually opt out of seeking a medical professional’s help to prevent exorbitant medical expenses.
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This is why the government initiated the Medicare health insurance program to finally give people a chance to get accessible medical treatments without the fear of being indebted.
This reliable healthcare plan offers comprehensive coverage for a wide range of medical expenses for millions of US citizens nationwide. You automatically become enrolled in Medicare when you reach the age of 65. Younger individuals also qualify for Medicare who have been diagnosed with amyotrophic lateral sclerosis, had renal failure, or have been receiving disability benefits from Social Security or the Railroad Retirement Board. With an adequate health insurance policy, you never have to worry about paying out-of-pocket expenses at the time of a medical emergency ever again.
But finding a robust healthcare plan that provides all the necessary benefits that you are seeking in a healthcare plan is not as simple as it seems. For a specialized health insurance plan that is best suited to your specific needs and situation, you will require an expert’s insight to guide you through the lengthy process of signing up for Medicare.
This is why at Integrity Now Insurance Brokers, our Medicare insurance agents are here to assist you and help you find a reliable healthcare plan that meets all of your special needs.
Our Medicare insurance agents are annually accredited by the AHIP and are well-versed in the complexities and dynamics of the industry. With our years of experience and access to premium Medicare insurance agencies in South Dakota, we will help you streamline comprehensive healthcare plans at the most competitive rates.
Get in touch with us today by giving us a call, and our independent Medicare insurance agents will help you compare quotes and provide you with all the details that you require.
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The Quick Guide on Different Medicare Options Available in South Dakota
Every person who is enrolling themselves in the Medicare program must choose between one of these healthcare programs to receive benefits from Medicare.
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Original Medicare
The Original Medicare program, also known as the traditional Medicare, is a popular fee-for-service program that is offered through the federal government. This comprehensive healthcare plan provides coverage for acute care medical treatments and consists of two parts: Part A and Part B.
Managed by the Center for Medicare & Medicaid Services (CMS), the Original Medicare plan does not provide coverage for prescription medication, so many beneficiaries like to purchase Medicare Part D plans, which specifically cover prescription drugs.
Medicare Part A plans offer coverage for services like specialized nursing facilities, inpatient hospital care (excluding custodial or long-term care), inpatient care in a religious non-medical healthcare institution, psychiatric care, home health care, and hospice care.
The Part B plan covers laboratory tests, certain medical equipment, physician services, blood work, mental health services, diagnostic X-rays, outpatient hospital services, and physical, occupational, and speech therapy.
Medicare has recently started to provide coverage for any medical treatment costs for people who have been diagnosed with a cognitive impairment like Alzheimer’s disease and other various forms of dementia. These healthcare treatments enable patients to go through clinical trials, get medical and non-medical treatments, and receive other additional benefits to live a higher quality of life.
These benefits involve cognition evaluation, function evaluation, measurement of neuropsychiatric symptoms, medication, identifying caregivers and caregiver needs, assessing care directives, and providing referrals to community services for the beneficiary and their caregiver.
The Original Medicare Part A and Part B plans only cover 80% of the overall medical expenses; this is why many people in South Dakota like to sign up for a secondary healthcare plan called Medigap to get coverage for whatever isn’t covered in the Original Medicare.
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Medicare Advantage – Part C
The Medicare Advantage plan or Medicare Part C is an all-in-one solution for people who are looking to combine all of their Medicare benefits into a single policy. This well-rounded coverage plan includes all the benefits of Part A, Part B, and Part D. This plan even provides its beneficiaries with additional benefits like dental, vision, hearing, discounted gym memberships, and other health and wellness support programs.
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Medicare Advantage provides its enrollees with a recommended network of healthcare providers to choose from at lower costs. These plans have lower out-of-pocket expenses like deductibles, coinsurances, and copayments compared to the Original Medicare plan. Medicare Part C plans also offer coverage for prescription drugs.
South Dakota’s Medicare Advantage program offers four different types of plans.
Health and Maintenance Organization
The HMO is a conglomeration of medical healthcare providers who provide beneficiaries with ample coverage for various medical treatments by a recommended network of hospitals and physicians that work under their terms and conditions.
HMOs require their enrollees to only opt for in-network healthcare providers to receive their healthcare benefits.
- Primary care provider (PCP) and specialty referral are required
- Most policies include prescription medication coverage
- Higher premiums and charges apply when opting for out-of-network healthcare providers.
Preferred Provider Organization
The PPO includes a network of healthcare providers that Medicare beneficiaries can choose from without paying any extra charges or premiums.
- PCP and a specialist’s referral are not required
- Drug coverage is included in most policies
- Higher premiums and charges apply for out-of-network healthcare providers
Private Fee-For-Service (PFFS)
This healthcare program is offered by State-licensed organizations that work under the terms and conditions of Medicare and Medicaid Services (CMS).
- No PCP or a specialty referral is required
- Drug coverage is included in most policies but beneficiaries can choose to purchase one separately
- Higher premiums and charges apply when opting for out-of-network providers
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Special Needs Plan (SNP)
The special needs plan limits its membership only to those people who have been diagnosed with specific chronic conditions and characteristics. This plan includes tailored healthcare benefits, drug formularies, and provider choices that have been specifically designed to meet the special needs of these people.
To become eligible for the special needs plan, you need to be enrolled in Medicare Part A, or Part B plans or has a chronic condition like AID/HIV, diabetes mellitus, dementia, cardiovascular diseases, cancer, auto-immune disorders, or a neurological disorder.
- PCP and a specialty referral are required
- Most plans include drug coverage
Medicare Part D
If your base healthcare plan does not include prescription drug coverage, you can always sign up for Medicare Part D. This healthcare plan specifically provides drug coverage and charges a monthly premium, an annual deductible, and other out-of-pocket expenses.
The costs of your Part D plan vary on the plan you sign up for.
Part D Deductible
A lot of the Part D policies have an annual deductible. The maximum deductible in 2022 is $480.
Initial Coverage Limit
Medicare beneficiaries will be expected to pay for 25% of the cost-sharing, and 75% will be covered by the plan.
Coverage Gap
Medicare Part D coverage gap begins after your drug plan has paid a certain amount for your prescription drugs. In 2022, this limit is $4,430. This amount changes annually, and you will be responsible for paying 25% of the plan’s costs for any brand-name drugs listed in your plan’s formulary.
Medigap – Supplemental Healthcare
Medigap or Medicare Supplement plans are a supplementary healthcare option that is funded by private insurance agencies to help cover any gaps left in the Original Medicare.
Each policy in this program is labeled from A to N. To qualify for Medigap:
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- The individual must be 65 years old or older
- Have been diagnosed with amyotrophic lateral sclerosis (ALS)
- Have been receiving disability benefits from Social Security or the Railroad Retirement Board.
- Have been diagnosed with end-stage renal disease(ESRD)
Medigap provides all the basic benefits of Original Medicare, including additional coverage for Part A and Part B coinsurances, hospice care copayments and coinsurances, Medicare preventive care deductibles, and three pints of blood.
Other additional benefits include specialized nursing facility deductibles, Part B excess charges, out-of-pocket yearly limit, and foreign travel emergency coverage.
Medigap insurers use three methods to calculate premiums.
Issue Age Rating
This approach for calculating premiums depends on the enrollee’s age and is less expensive for younger subscribers. The overall costs might change due to inflation and other reasons but are never affected due to a person’s age.
Attained-Age Rating
In this approach, the premiums get higher as the person advances in age. These premiums are less costly for younger subscribers, and many insurers prefer using this method to calculate premiums.
Community Rating
In this method, the premiums are not affected by the enrollee’s age. Eight states in the US mandate this approach, but many insurance companies tend to avoid it.
When signing up for Medicare, many people tend to feel overwhelmed with the number of choices that they have. But our Medicare insurance agents aim to simplify things as much as they can and can help you formulate efficient healthcare policies that provide ample coverage for all of your specific needs and requirements.
To learn more about the different Medicare plans available in South Dakota, make sure to go through our resources and find comprehensive guides on how to sign up for Medicare. You can also use our Medicare plan finder tool to check out all the Medicare Advantage plans available in your region.
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Comparing Medicare Plans in South Dakota
Here are some factors you should consider before enrolling yourself in a Medicare health insurance plan.
Provider Network
Many Medicare plans provide their enrollees with a network of healthcare providers to choose from. You can save a lot of money by opting for in-network providers since out-of-network providers have higher premiums and extra charges.
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Make sure to find out about any hospitals and physicians that are a part of your plans’ network to prevent excessive premiums and charges.
Amount of Coverage Required
Make a list of all the goals you’re looking to achieve with your healthcare plan. Medicare Advantage and Medigap plans typically include additional benefits like dental benefits, vision benefits, hearing benefits, and other wellness programs.
Keep your goal in mind and find a plan that is best suited to your situation.
Plant Ratings
To compare the different plan ratings in your area, make sure to go through the Part C and Part D performance data published by the Centers for Medicare & Medicaid Services (CMS) every year.
Out-of-Pocket Max
You will be responsible for paying out-of-pocket expenses like coinsurances, deductibles, and copayments. These expenses are a part of almost every Medicare-covered service.
Coinsurance and Copayments
Also known as cost-sharing, you will be responsible for paying any coinsurance and copayments when you exercise your Medicare benefits.
Find out how much your insurance plan covers for doctor appointments, treatments, prescription medications, and other healthcare services.
Drug Coverage
Prescription medication is expensive, and you might want to make sure that the health insurance plan you’re investing in includes coverage for drugs.
Find out if the drugs you’re being prescribed are enlisted in your plan’s formulary. If not, you can ask your physician for any alternate or generic versions of these drugs that are covered by your plan.
Extra Benefits
Most Medicare Advantage plans cover prescription medications and include added benefits like vision, dental, hearing, and other targeted treatments.
Think about any additional benefits that are crucial for your situation and purchase a plan that covers all of your primary needs.
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Why Trust Medicare Insurance Agents at Integrity Now Insurance Brokers?
At Integrity Now Insurance Brokers, our Medicare Hope insurance agents have extensive experience when it comes to streamlining comprehensive insurance plans at the most affordable rates.
Our Medicare insurance agents have helped countless of our clients find the most well-rounded insurance plans and get ample coverage for all of their necessary medical treatments.
We partner with numerous top-rated Medicare insurance providers across South Dakota that we carefully selected due to their past stellar records and reliable health insurance policies.
Give us a call today, and we can help you compare quotes and make sure all of your specific needs and requirements are met.
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