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Consumer Resource Guide to Understanding the Health Insurance Marketplace

There is an overwhelming amount of information in regards to your health insurance options, as well as new legislature, laws, and even penalties that not everyone may be aware of. The resources and articles provided here will enable consumers to gain the understanding they need of crucial elements affecting their personal health insurance needs.

You can begin your research now by clicking relevant links and articles below that pertain to questions you may have regarding your health insurance options.

Understanding the Basics of Medicare

To help ensure that all Americans have access to health care, the federal government offers several programs that provide health insurance coverage. For senior citizens over the age of 65, applying to Medicare offers affordable health care at a lower cost than most private insurance. However, Medicare does not cover all the costs associated with healthcare. To afford those costs, many seniors turn to supplemental health insurance.

Medicare's Components

Created by the federal government in 1965, Medicare has evolved over time. The various components of the program are known as Parts A, B, C, and D. In addition, seniors have many low-cost options for health coverage that supplements Medicare. These options and components are frequently confusing for seniors, so an in-depth explanation of all of Medicare is helpful:

Parts A and B

When Medicare was created, it was primarily designed to cover hospital stays and doctors' visits - two of the biggest medical costs in the mid-1960s. Medicare Part A is insurance that kicks in anytime a senior is admitted to a medical facility and the procedures that are performed during that visit (e.g. a major surgery). This component of Medicare also pays for hospital stays of any length.

Medicare Part B covers treatment that does not involve overnight stays. This includes preventive and medically necessary doctors' visits, simple outpatient procedures, and services like medical rehab. It is important for seniors to understand that both Parts A and B do not cover seniors' medical costs in full. If the cost of care exceeds the amount that Medicare covers, seniors are responsible for ensuring the doctor, hospital or service provider is paid in full.

Part C

As Medicare evolved, seniors were given another option: Medicare Part C plans, which are typically known as Medicare Advantage plans. Medicare Part C plans are "private" plans that are sold by private insurance companies, although seniors receive government subsidies to buy them. In addition to the benefits that seniors receive through Medicare Parts A and B, Medicare Part C plans include additional coverage. For instance, many Medicare Advantage plans include dental and vision coverage, as well as some level of benefits for both brand-name and generic prescription drugs. Seniors can sometimes save money with Medicare Advantage plans because out-of-pocket costs are frequently lower with these plans than with Medicare Parts A and B.

Part D

To help seniors address the high cost of important prescription drugs, the federal government created the Medicare Part D benefit in 2005. Each Part D plan is offered by a private insurance carrier after careful approval by the authorities that oversee Medicare. Each plan supplements the coverage of seniors who enroll in Parts A and B, and each plan differs in the level of coverage and the overall cost. Seniors that need prescription drug coverage can buy Part D coverage regardless of their health or income, and governmental assistance through the Social Security Administration is available to some low-income seniors.

"Medigap" Supplemental Coverage

Medical services or devices not covered by Medicare Parts A, B, C, or D are known as gaps in coverage. Some private insurance carriers offer so-called Medigap plans that provide supplemental coverage to fill these gaps. If a senior decides to buy Medigap coverage, there are many options to choose from. Seniors are frequently advised to make a choice based on the level of coverage they need and the premium price they prefer. Seniors are required by law to pay their premiums for Medigap plans on time; if they do not, the insurance carrier may terminate their coverage.

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