Medicare and Medicaid are governmental programs that offer medical and health-related services to particular groups of people in the United States. Both the programs come under the management of the Centers for Medicare and Medicaid Services.
Call us at 407-344-1228 to schedule your FREE Medicare consultation, or email us at [email protected] for any insurance needs you may have.
Created by President Lyndon B. Johnson under the amendments made to the Social Security Act on July 30, 1965, Medicaid and Medicare are social welfare and social insurance programs respectively. Medicaid offers social protection and serves about 66.6 million people in the country. Medicare, being a social insurance program, has over 56 million enrollees.
What is Medicare?
Medicare in Kissimmee, Floridais a federally-administrated health insurance program that pays for the hospitals and medical care for the citizens of the United States who are older or with disabilities. There is a certain criterion for Medicare that you have to meet if you want to avail the benefits of the program. The Medicare in Kissimmee, Floridaconsists of four parts: A, B, C, and D.
Part A and Part B of the Original Medicareconsist of the hospital and medical insurance, whereas Part C and Part D make up two additional parts that provide flexibility and prescription drugs. The Part A of Medicare in Kissimmee, Floridahelps you pay for the hospital stays and other health-related services.
The hospital support offered under the programs includes meals, supplies, testing, and coverage of bills for a semi-private room. It also covers physical therapy, occupational therapy, and speech therapy. In the same part of the Medicare in Kissimmee, Florida,you can avail care in a skilled nursing facility and equipment like walkers and wheelchairs for older people.
Part B of Medicare in Kissimmee, Floridapays for specific health services like preventive care services, home healthcare costs, mandatory physician visits, and outpatient hospital visits. You won’t have to pay for services such as vaccinations, blood transfusion, ambulance transportation on some occasions, chemotherapy, and prosthetic devices.
What is Medicare Advantage?
Medicare AdvantagePlans or Medicare+ Choice is basically the additional Part C of the Original Medicare in Kissimmee, Florida.It allows you to design a custom plan for yourself. You can modify it as per your medical needs. Medicare Advantageentails all the offerings of Part A and Part B of the original plan alongside additional health services such as dental, vision, and hearing.
You will have to choose from a list of private insurance companies to provide the coverage. The details of the program and your eligibility have a lot of say in the services that would be offered to you through this part of Medicare in Kissimmee, Florida.
Medicare AdvantagePlans are deemed as an all-in-one alternative to the original Medicare. These plans are offered by private companies that are approved by Medicare in Kissimmee, Florida.A fixed amount for care is paid on a monthly basis.
However, each Medicare AdvantagePlan can charge you differently and have different rules for certain services. For instance, there are different rules if you need a referral to see a specialist, or if you have to go to doctors for non-urgent care.
Advantages of Original Medicare:
The main advantages of OriginalMedicare in Kissimmee, Floridainclude:
- Low Monthly Premiums
Medicare Part A is premium free for most of the people. The standard premium starts for Part B at $135.50 per month. This premium only increases if your income is higher. You only have to pay $130 a month if you want to receive Social Security benefits through the Original Medicare.
- Increased Flexibility
Original Medicare offers a broad range of flexibility in terms of healthcare providers. Almost 9 out of 10 doctors accept plans under Medicare in Kissimmee, Florida. This allows you to have a greater selection to choose from.
- Increased Eligibility
Part A and B of Medicare in Kissimmee, Floridahave broader eligibility criteria. You have to meet the following requirements to start availing the benefits of the program:
- The age must be at least 65 years
- You must be a citizen of the United States or a legal permanent resident for at least 5 years
- For under 65 years age, you have a qualifying disability or medical condition such as Lou Gehrig’s Disease or End-Stage Renal Disease
- Far-stretched Coverage
The Original Medicareis applicable in all fifty states of the country and in the District of Columbia. Not just this, you’ll also be able to acquire the benefits of this social insurance program in areas including Puerto Rico, S. Virgin Islands, Guam, American Samoa and the Northern Mariana Islands.
Disadvantages of Original Medicare:
Here are some of the disadvantages of OriginalMedicare in Kissimmee, Florida.
- Co-pays and Co-insurance Costs
Once you have met deductibles for premium-free services of Original Medicare Part A and Part B, you will have to pay out of pocket in the form of co-insurances and co-pays. The Medicare in Kissimmee, Floridatypically covers 80% of the cost and you have to pay for the remaining 20%.
- Incomplete Care Coverage
Part A and Part B of the Original Medicare program do not cover health services such as eye care, hearing or dental services. If you want to get a dental checkup or want to visit an eye specialist, it won’t be covered in your insurance plan under the OriginalMedicare in Kissimmee, Florida.You have to pay for the visit on your own.
- No Limit for Out-Of-Pocket Payments
As mentioned, you will have to pay for 20% of the medical bills as the original plan only offers coverage for 80%. Another drawback of the plan is that there is no out-of-pocket payment limit. Being a beneficiary, you cannot determine the amount you will have to pay on your own annually to cover the health care services.
- Prescription Drug and Health Item Coverage
Besides lack of coverage for dental, optical and hearing-related health services, the Original Medicaredoesn’t cover items like prescription drugs, dentures, eyeglasses, and hearing aids. Also, if you want to join a fitness club or get a gym membership for healthy living, it wouldn’t be covered in Part A and B of the Original Medicare.
Advantages of Medicare Advantage:
If you analyze Medicare Advantage, the following are the benefits you will be able to acquire from this federally offered insurance program.
- Additional Coverage
The Advantage Plan in Medicare in Kissimmee, Floridaoffers extra coverage. It includes all the benefits offered by Part A and B of the Original Medicareand has more services under its umbrella too. This includes health services like vision, hearing and dental services. It also has coverage for health and wellness programs which aren’t included in the former.
- Convenient Payment
Medicare AdvantagePlans offer the option of convenient payment. It is a “pay as you go” kind of a plan that has little to no premium. Aside from the Medicare Part B premium, you only have to pay occasionally. For instance, if you see a doctor only once in a while, or do not use medical providers often, you can save money on a monthly basis through Medicare Advantage.
- All-in-one Plan
Having a Medicare Advantagecard can take care of all your medical, and hospital benefits. Even prescription drugs can be paid for by showing this card. So, this way you don’t have to carry separate cards for each benefit.
Disadvantages of Medicare Advantage:
There are a couple of disadvantages for the Advantage Plan of Medicare in Kissimmee, Florida. They are discussed underneath.
- Strict Rules
Medicare Advantage Plans have strict rules. You can only seek care from a predefined network of health care providers. If you go out of the network, you will be charged at a much higher price. The only situation in which they allow you to get service of an outside physician is when there is an emergency.
- Area Restricted
If you choose Advantage Plans for Medicare in Kissimmee, Florida,you will only be able to achieve benefits within the enrolled area. If you move out, you will lose the plan and won’t be a part of the network anymore.
- Changed Benefits
Medicare Advantageplans change every year. Their benefits and coverage are upgraded on January 1. You have to remain updated with the changes to determine whether or not the plan is still suited for you. It’s best that you contact a representative or insurance advisor to avoid any inconvenience.
There’s an ongoing debate regarding Original Medicareand the MedicareAdvantagethat which of them is better. Both of them have their respective positive and negative attributes. The key difference between the two is how accessible doctors are and what clinics and providers you can reach out to. MedicareAdvantage may restrict you to a certain area, but offers you better coverage. With Original Medicare, you can present the card at any place in the country and get access to the physician.
If you want to select the best plan of Medicare in Kissimmee, Florida,you need to do extensive research and get help from insurance advisor to help you determine which plan suits you best.
Call us at 407-344-1228 to schedule your FREE Medicare consultation, or email us at [email protected] for any insurance needs you may have.