Medicare Explained
Courtesy Select Health, Salt Lake City LIVING WELL Magazine
If you have questions about Medicare, you’re not alone. Let’s start with the basics: what is Medicare? Medicare is healthcare coverage sponsored by the federal government. It was originally intended to provide health insurance to people on Social Security. A person is eligible for Medicare if they or their spouse worked for at least 10 years in Medicare-covered employment, are 65 years or older, and a citizen or permanent resident of the United States. Those younger than 65 might also qualify for coverage, if they have a disability or have end-stage renal disease, which is permanent kidney failure requiring dialysis or transplant.
When thinking about Medicare, be careful not to confuse it with Medicaid. Medicaid is a different government healthcare program designed primarily for people with lower incomes, people with disabilities, and some families and children.
Medicare is divided into four parts that participants can choose from: Parts A, B, C, and D. Each of these parts provide different types of medical coverage and may have premiums associated with them.
Let’s take a look at Parts A, B, and D first.
Medicare Part A is known as hospital insurance. Specifically, Part A helps cover inpatient care in hospitals, skilled nursing facilities, hospice, and home health care. The key word to remember about this coverage is “inpatient.” That’s because for this coverage to kick in, the patient must be formally admitted to a hospital with a doctor’s order.
The good news about Part A is that anyone who paid Medicare taxes for at least 10 years gets it for free. Well, okay, they did pay all those taxes, but the point is that they won’t have to pay any premiums for Part A hospital coverage.
Medicare Part B is known as medical insurance. Part B helps cover doctors’ and other health care providers’ services, outpatient care, durable medical equipment, and home health care. It also helps cover some preventive services to help maintain beneficiaries’ health and to keep certain illnesses from getting worse.
Unlike Part A, all participants have to pay a premium for Part B coverage.
Medicare Part D is Prescription Drug Coverage. Part D helps cover the cost of prescription drugs, may help lower prescription drug costs and helps protect against higher costs in the future. All Part D plans are run by Medicare-approved private insurance companies.
Medicare Parts A, B, and D function independently of each other and can sometimes be difficult to coordinate and understand. For those who would prefer a single plan, there is Medicare Part C, also known as Medicare Advantage. Medicare Advantage plans provide the benefits and services of Parts A, B, and usually D through a Medicare-approved private insurance company.
While each Medicare Advantage Plan is different, generally the following reasons make a compelling argument for choosing Part C:
• First, co-payments and deductibles in most Medicare Advantage plans are often lower than traditional Medicare.
• Medicare Advantage Plans generally offer additional benefits such as dental, vision, or even fitness and wellness programs.
• Also, Medicare Advantage plans provide a network of contracted doctors, meaning that plan members don’t have to hunt down a doctor who will accept their Medicare card.
• And if a beneficiary is unhappy with the service they’ve received from their Medicare Advantage plan, Part C provides them with a marketplace of providers to choose from.
There are strict enrollment periods when someone can enroll into Medicare A and B, or choose a Medicare Advantage Plan (Part C). Generally, open enrollment periods run from mid-October to early December.
One other thing, for all the procrastinators out there, if a participant does not sign up for Medicare Parts B and D when they are first eligible, they may have to pay late enrollment penalties.
Remembering the As, Bs, Cs, and Ds of Medicare can be confusing; to help you remember the differences, use this quick memory association technique.
Part A is hospital insurance, and if someone has to go to the hospital, there’s a good chance they’re screaming “Aaaahh.” Clever, right? So try to visualize that in your mind.
Part B is medical insurance, you know, for when you need to go see the doctor because you’re feeling “Bleh.” Got it?
Part D is drugs. D is for drugs, enough said.
Part C is a Medicare Advantage Plan, which is just a private insurance company offering the equivalent of Parts A, B, and usually D. So it’s complete, comprehensive.
And now you know the As, Bs, Cs and Ds of Medicare. For more information and specifics about the various parts of Medicare, be sure to visit medicare.gov.
