Medicare Insurance in Orange County
If you’re 65 or older, the chances are great that even if you aren’t using Medicare benefits, you have at least heard about it. If you still aren’t entirely sure what Medicare covers or what you have to do to get Medicare then this guide is for you. There are resources located right here in Orange County as well as online to help you learn about your coverage and even find approved doctors or care in your area.
What is Medicare?
Medicare is a health care plan that is funded by the federal government and exclusive for seniors 65 and older or certain younger people that have met disability and those people with permanent kidney failure. You’ll be able to get benefits through four different parts and you have the ability to customize your plan to fit your needs.
4 Different parts of Medicare
It covers hospital insurance. The time and duration of your stay at a hospital or an approved skilled nursing facility, this will be covered under Part A. This can also cover hospice care and other home health care options.
It covers medical insurance. This applies when you go to the doctor or get any type of outpatient or preventative care, this will be covered under Part B. This can also cover the cost of medical supplies that were utilized throughout the duration of your medication.
It is a plan that allows you to customize your care. It’s called Medicare Advantage Plan and allows private companies to cover benefits in Part A and B at the same time giving them the ability to also their own prescription drug coverage.
It is the additional prescription coverage that can be added on to Part A and B.
Types of Medicare Plans
A Health Maintenance Organization usually requires patients to use health care providers and pharmacies that are part of the plan’s network (except in the case of emergencies) while also typically require a referral from a primary care doctor in order to see a specialist.
Medicare Advantage beneficiaries in a Preferred Provider Organization are able to see providers outside of their plan’s network, often at a higher cost. Beneficiaries in this type of plan typically pay less out of pocket if they choose to receive medical services from providers within their plan’s network. PPO plans typically do not require patients to acquire a referral before visiting with a specialist.
A Private Fee-For-Service plan determines how much it will pay to health care providers and how much the patient will pay when care is received. With a PFFS plan, you can typically receive care from any doctor, hospital or health care provider that accepts your plan’s terms. Not all providers will accept these terms, however.
A Special Needs Plan is a type of Medicare Advantage plan limited to people with certain chronic conditions and other specific characteristics. Typically, you must receive care from health care providers and hospitals within your SNP network, except for in cases when you need emergency or urgent care and when someone who has End-Stage Renal Disease (ESRD) needs out-of-area kidney dialysis.