Medicare Advantage: Basic Terms to Know
Claim
A payment request submitted to insurance providers for services that you believe are covered.
Deductible
The overall cost for health care services or prescriptions which must be paid before insurance plans will pay anything.
Premium
The amount paid by the insured party to the insurance company.
Medicare Parts: Simplified
Medicare Part A
Inpatient care in a hospital, Skilled nursing facility care, Nursing home care (inpatient care in a skilled nursing facility that’s not custodial or long-term care), Hospice care, Home health care.
Medicare Part B
Helps covers physician services, outpatient hospital services, certain home health services, durable medical equipment, and certain other medical and health services not covered by Medicare Part A.
Medicare Part C
A Medicare Advantage Plan (like an HMO or PPO) is another Medicare health plan choice you may have as part of Medicare. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare.
Medicare Part D
Helps covers prescription drug benefits.
Factors that Affect Medicare Advantage Plan Costs
Certain parts of your profile affect your Medicare Advantage Plan Costs more than others, and every insurance company has their own specific formula to determine your premiums.The following are the most heavily weighted factors used to determine Medicare Advantage Plan Costs:
Part A Premiums
Original Medicare recipients do not pay any premiums if they are over 65 and:
-Collect retirement benefits from Social Security or the Railroad Retirement Board.
-Qualify for Social Security or Railroad benefits not yet claimed.
-Employment with a Medicare-covered government agency.
Part B Premiums
Medicare Part B is a premium that changes annually, determined by modified adjusted gross income and your tax filing status. However, it will be more if you reported above a certain level of modified adjusted gross income on your federal tax return two years ago.
Part C Premiums
Premium will vary depending on the insurance company you pick.
Part D Premiums
Premium will vary depending on the insurance company you pick.
