Numerous senior citizens in the US rely on government-run healthcare programs to receive adequate healthcare coverage and get ample support whenever they face an inevitable medical emergency. But since so many people are still unaware of various organizations’ different comprehensive coverage policies, almost 16 million adults are currently going through medical debt and owe more than $10,000.
Medicare is a government-backed healthcare program that offers ample coverage for a wide range of medical expenses for millions of US citizens nationwide. This health insurance providing network is one of the most reliable health insurance providers and finally gives people a chance to get health coverage without going through any medical debt.
You automatically become enrolled in Medicare when you reach the age of 65 or have been receiving disability benefits from Social Security or the Railroad Retirement Board. With a well-rounded health insurance program, you never have to worry about paying any extra out-of-pocket expenses at the time of a medical emergency ever again.
The key to receiving maximum healthcare benefits from Medicare is to find a health insurance plan that is perfectly suitable for your specific needs and requirements and is also within budget. But the process of finding a robust healthcare plan can seem lengthy and intimidating.
This is why at Integrity Now Insurance Brokers, our Medicare insurance agents are dedicated to simplifying things and helping you streamline the most reliable health insurance plans at competitive rates. Our Medicare insurance agents are annually accredited by the American Health Insurance Plans (AHIP) and are well-versed with the dynamics of the insurance industry.
With our extensive experience and access to numerous A-rated Medicare insurance agencies in Virginia, we assure you that you are in safe hands.
To discuss all the Medicare options available in your region, get in touch with our Medicare insurance agents by giving us a call, and we will provide you with all the details that you require.
A Guide on Different Medicare Options Available in Virginia
Every person who is considering enrolling themselves in the Medicare program in Virginia must choose between the following different Medicare options.
The Original Medicare program, also known as the traditional Medicare, is one of the most popular fee-for-service Medicare options in Virginia that is offered through the federal government. This healthcare plan includes Medicare Part A (Hospital Insurance) and Part B (Medical insurance).
The Original Medicare plans are managed by the Centers for Medicare & Medicaid Services (CMS). The Part A plans provide coverage for services like inpatient hospital care, skilled nursing facilities (excluding custodial or long-term care), inpatient care in religious non-medical healthcare facilities, psychiatric care, home health care, and hospice care.
The Part B plan covers a wide range of medical expenses like laboratory tests, medical equipment, blood work, mental health care, diagnostic X-rays, outpatient hospital services, and physical, occupational, and speech therapy.
The Original Medicare plan also recently has started to provide comprehensive healthcare coverage for people who have been diagnosed with a cognitive impairment like Alzheimer’s disease and other forms of dementia. These healthcare options enable patients to get ample coverage of clinical trials and medical and non-medical treatments, including other additional benefits that enable these people to live a healthier life.
These benefits include evaluation of cognition and function, measurement of neuropsychiatric symptoms, medication, identifying caregivers and their needs, assessing care directives, and providing referrals to community services for the beneficiary and the caregiver.
Medicare Advantage – Part C Plans
The Part C plans are offered by private insurers that work under the terms and conditions of Medicare. To join the Medicare Advantage plan, you must already be enrolled in Medicare Part A and Part B Plans.
These plans are an all-in-one solution for people who are looking to combine all of their Medicare benefits into a single policy. The Medicare Advantage plan also includes additional health benefits like coverage for dental, vision, hearing, discounted gym memberships, and other health and fitness programs.
When signing up for Medicare Advantage, you will be provided with a recommended network of healthcare providers for lower costs. Medicare Advantage copayments, coinsurances, and deductibles are much lower compared to the Original Medicare, and most of their plans even have drug coverage.
Virginia’s Medicare Advantage program offers four different types of plans.
Health and Maintenance Organization (HMO)
The HMO is a type of managed healthcare plan that provides its subscribers with a list of in-network providers. HMOs have several restrictions on the network of providers that they have, and they abstain from paying for any services sourced from out-of-network hospitals and physicians (unless it is an emergency).
The HMO does require its subscribers to obtain a primary care provider (PCP) and a specialty referral before exercising their healthcare benefits. Most of their plans include coverage for prescription drugs.
Preferred Provider Plan (PPP)
This healthcare plan is funded by private insurance companies in Virginia, and provide a specific amount of benefits for in-network providers and a lesser amount if out-of-network providers are used.
To qualify, you will not require a PCP or a specialty referral, and drug coverage is included in most of these plans.
Private Fee-For-Service (PFFS)
The PFFS plan is another plan that is funded by private insurance companies that work under the terms and conditions of Medicare. When signing up, no PCP or a specialty referral is required. Drug coverage is included in most of the policies but can also be purchased separately. Subscribers usually pay more when opting for out-of-network providers.
Special Needs Plan (SNP)
The SNP health insurance plan limits its membership to people who have been diagnosed with specific chronic conditions and disabling characteristics. The SNP plan is available in limited areas and is specifically designed to meet the special needs of people who have special requirements.
This plan includes tailored benefits, drug formularies, and provider options that serve the needs of these people. To qualify for this plan, you must have a chronic condition like HIV/AIDs, dementia, diabetes mellitus, cardiovascular disorders, cancer, neurological disorders, etc.
You will also require a PCP and a specialty referral before you sign up for the SNP.
Medicare Part D
Many Original Medicare beneficiaries like to purchase the Medicare Part D plans, which specifically provide coverage for prescription drugs since the Original Medicare does not offer drug coverage. Like other health insurance plans, the Part D plans also charge a monthly premium, an annual deductible, and other out-of-pocket expenses.
You can add Part D plans to your Original Medicare plan or another healthcare plan like the PFFS or PPP. The Part D plans cover all brand-name and generic drugs. All plans typically cover drugs from all categories, but sometimes these plans can have specific formularies, including drugs from each category.
Part D Deductible
Several of the Part D policies have an annual deductible. The maximum deductible in 2022 for Part D subscribers is $480.
Initial Coverage Limit
Medicare beneficiaries will be expected to pay 25% of the cost-sharing, and 75% will be covered by their drug plan.
Medicare Part D coverage gap begins after your drug plan has paid a certain amount of your prescription drugs. In 2022, this limit is $4,430. This amount changes almost annually, and you will be expected to pay 25% of the plan’s cost for any brand-name drugs listed in your plan’s formulary.
Medigap – Supplemental Healthcare
Medigap or Medicare Supplement plans are funded by private insurance companies in Virginia that fill out all the gaps in the Original Medicare plan. Each plan in this program is labeled from A to N, and each letter has a certain level of coverage.
Medigap provides all the basic benefits of the Original Medicare, including coverage for all Part A and Part B coinsurances, hospice care copayments and coinsurances, Medicare preventive care deductibles, and the first three pints of blood.
Additional benefits include specialized nursing facilities care deductibles, Part B excess charges, out-of-pocket yearly limit, and foreign travel emergency coverage.
Medigap insurers calculate their premiums using three different approaches.
Issue Age Rating
This approach for calculating premiums depends on the enrollee’s age and is less costly for younger people. The overall costs are never affected due to the person’s age.
In the attained-age rating method, the premiums are much cheaper for younger individuals. Many insurers like to use this approach unless mandated to do otherwise.
Eight states in the US have mandated this method of calculating premiums, while many insurers tend to avoid it.
When finding the right health insurance plan, it’s not uncommon for people to feel overwhelmed and intimidated by the amount of research required. There are various options to choose from, and finding the one that is best suited to your situation can be difficult.
This is why at Integrity Now Insurance Brokers, our highly qualified Medicare insurance agents are committed to making your job easier and can help you streamline the most well-rounded healthcare plans at competitive rates.
We have years of experience in helping people land comprehensive health insurance policies because we prioritize your health before anything else. To learn more about the different Medicare plans available in Virginia, make sure to go through our resources and find out all there is about signing up for Medicare.
Comparing Medicare Plans in Virginia
Here are some factors you should consider before signing up for Medicare.
If you’re looking to prevent excessive medical charges, choose in-network healthcare providers since out-of-network providers usually have higher premiums and charges. You can save a significant amount of money by just opting for an in-network provider.
Amount of Coverage Required
Before you sign up for a plan, make sure to do your research and find a plan that has all the benefits that you require.
Medicare Advantage and Medigap plans usually include additional benefits like dental, vision, hearing, and other targeted treatments that aren’t covered in Original Medicare.
Check Plan Ratings
To compare different plan ratings in your area, you can check out the Part C and Part D performance data that is annually released by the Center for Medicare & Medicaid Services (CMS).
Deductibles, Copayments, and Coinsurances
These out-of-pocket payments are the maximum amount that you’ll be expected to pay if you adhere to the in and out-of-network guidelines of Medicare.
To compare the pricing on different plans in Virginia, you can use our plan finder tool.
Prescription medication is costly, and it is recommended to invest in an appropriate plan that also includes ample coverage for prescription medication.
Make sure to check your plans’ formulary and see whether it includes the drugs you’re usually prescribed. If not, you can ask your physician for an alternate or generic version of the drug.
Who Can Get Medicare?
To become eligible for Medicare;
- You must be 65 years old or older
- If younger, you must be receiving disability benefits from Social Security or the Railroad Retirement Board
- You and your spouse must be government employees or a retiree that has paid the Medicare payroll taxes
- You must be collecting a disability pension from Railroad Retirement Board
- You have been diagnosed with Lou Gehrig’s disease (amyotrophic lateral sclerosis)
- You have permanent kidney failure, end-stage renal disease, or require regular dialysis
Why Choose Medicare Insurance Agents at Integrity Now Insurance Brokers?
Medicare insurance agents at Integrity Now Insurance brokers are a certified team of highly qualified insurance agents who have helped countless of our clients devise the most comprehensive health insurance plans all over Virginia.
We partner with premium Medicare insurance agencies in the US and are committed to helping you formulate the most efficient healthcare plans best suited to your specific needs and requirements.
Our independent Medicare insurance agents offer free of charge assistance 24/7 and will guide you line by line through every insurance policy to help you find the one that has proper coverage along with additional benefits.
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