Managed by the Government Program called CMC (Center For Medicare and Medicaid Services). Medicare is a Federally funded health insurance program for those over 65, and sometimes for disabled ones in certain circumstances that are under the age of 65.
There are 2 different ways for you to get Medicare coverage.
- Regular Medicare which is run and issued through the Medicare Government run insurance program (CMC). You have to enroll during your open enrollment period based on your birth month of turning age 65.
- Through a Federally Contracted Private Insurance Carrier with a Medicare Advantage Plan. Most of the major health insurance carriers in the US offer different Medicare Advantage plans.
When you first sign up for Medicare you are signing up for a Standard Medicare Plan which is called Part A. At the same time you enroll, you have the option to purchase Plan B. (NOTE: If you do not purchase part B at the original time you sign up for part A, you may have to pay a late enrollment fee).
Part A and Part B are the basic parts that make up Standard Medicare.
Lets breakdown each of these plans a little more.
Medicare Part A
Most people are automatically enrolled into Standard Medicare when they turn 65. They usually have had to have paid in Medicare taxes while working for a certain amount of time. Known as Medicare HOSPITAL Insurance, this policy may cover you for things such as:
- Inpatient Hospital Stays.
- Stays at a Skilled Nursing Facility.
- Hospice Care Needs.
- Home Health Care ( if the patients qualifies through Medicare)
The plan will cover any medical equipment or medical services that are used to treat the patient’s condition. This includes Rx Prescription drugs that are part of the stay, as well as Nurse and private room services if these are required during treatment.
Long Term Care such as a nursing home or a long term care facility are NOT covered under Plan A. It only covers limited skilled nursing care related directly to the patients treatment.
Plan A will cover terminal illness hospice care. If you are said to have a terminal illness by your doctor and expected to live for only 6 month or less, Part A will cover the expenses during this time. It usually covers all doctors and skilled nursing including the Rx’s needed to control the symptoms.
Usually Medicare Part A comes free. However, if you have not worked the minimum amount of time paying required paying in Medicare Taxes (10 Years) you have to purchase part A. The rate is based on how many quarters you have paid into Medicare Taxes. In either case, there are usually deductibles and copayments required for services.
Medicare Part B
Most people are required to purchase Part B of Medicare. This portion is more for the outpatients services required for the patient. Some of these are:
- Doctor Visits.
- Medical Equipment.
- Lab Testing and the Results.
- Mental HealCare Needs.
- Ambulance coverage in the case of an emergency.
- Preventive coverage.
- Medical equipment if it is necessary for your well being. Canes, Walkers, Hospital Beds, etc.
With the preventive coverage, this includes the necessary needs to keep you healthy and to diagnose potential health conditions early on. Some of these preventive coverage include
- Annual Wellness Exams.
- Health Screenings.
- Vaccines such as the Flu Shot or Pneumonia Shot.
- and more.
There is some coverage for Rx drugs, but it is by no means a comprehensive plan. Only those administered by a doctor are usually covered under Plan B. For a more comprehensive Rx plan, you will want to look into another plan called Medicare Part D which is an additional plan that can be purchased.
Plan B is also susceptible to monthly premiums. These are usually based on your income level from your taxable income from 2 years prior. Usually you will also have copayments and/or an annual deductible depending on the services you are receiving.
How Much Do I Have to Pay for Plan D? See the chart Below.
These again were the 2 “main” or “standard plans”
Plan C or Medicare Advantage Plan.
These are the plans carried through the private sector of the insurance industry. Even when you are signed up for a Medicare Advantage Plan you are still enrolled in Medicare so no need to try and enroll in both.
These companies are contracted, and the plans they offer can be different from one carrier to the next. You still receive the same basic coverages as each plan includes the coverages in Part A and Part B, but the plans can come with some additional coverages such as:
- Annual Vision Care.
- Dental Care.
- Prescription Rx Coverage. (If you have a Medicare Advantage Plan with Rx coverage, you will probably not need to purchase the Rx Medicare Plan D).
- Wellness Programs.
- Hearing Care such as testing and hearing aids.
- and more.
Again each plan differs between each carrier. These Plans come in many different forms as well. They can be a HMO or PPO or something else different. These are more widely recognizable by most as these are the types of plans that you probably had if you have had insurance coverage through work. They cover a more extensive amount of preventive and doctor visit needs.
Medicare Part D
Standard Medicare (Part A and Part B) are very limited when it comes to Rx benefits and coverages. Those enrolled can sign up for an additional coverage called Medicare Part D or Prescription Drug Coverage.
This help offset the costs of Rx prescriptions that you are prescribed to by your doctor. This can be purchased in addition to the Medicare Standard Plan and can also be included if you decide to go with a Medicare Advantage Plan.
Medicare Supplement Plans
These are additional coverages that are sometimes called MediGap coverages. This type of plan can help “fill in the gaps” where your Standard Medicare Coverage does not pay. Some examples of when a MediGap or Supplement Plans can help are :
- When Coinsurance doesn’t cover a certain treatment or need.
- Help with the costs of Copayments.
- Emergency Care.
- Overseas Care for Emergencies.
- Annual Deductibles.
- and more. Each plan varies on the insurance carrier.
This was just a quick overview of how Medicare works and its different plans. Please contact your Agent or Medicare directly, or have your personal care assistant help you decide which plan best suits your needs. Each person’s circumstances are different and one plan can be more beneficial than others for you personally.