What Is Medicare?

MEDICARE PART A: Medicare Part A is sometimes described as Hospital Insurance a term that is used to distinguish it from Part B. But it is important to note that the term ‘Hospital Insurance” can be somewhat misleading. A lot of times people assume that Part A pays all of their bill if they were to be placed in a hospital, but that is not true. The services that you receive from doctors, surgeons, or anesthetics while you are in the hospital are billed separately and are only covered by Part B of Medicare. In addition you  have to meet an annual deductible for services and there are additional limitations and co-pays that you may incur for things like skilled nursing care.

A better way to describe Medicare Part A would be coverage primarily for nursing care. It helps pay for the following:

*The services of professional nurses when you are admitted to a hospital or a skilled nursing facility.

* The cost of a Semi-private room in an hospital or nursing facility.

*Meals that are provided by the hospital or nursing facility

*Services that are provided directly by the hospital or nursing facility, such as labs, drugs or medical supplies provided by the facility.

*Home Health Services if you qualify for nursing care at home.

*All services provided by a Hospice Program

Most of the people that have Medicare Part A  do not pay a premium for it. That is because Part A has been paid for throughout the years that you have worked from Medicare Payroll Taxes. The only people that have to pay for Part A benefits are those that have not accumulated enough credits from working, this mostly applies to new immigrants.

MEDICARE PART B: Medicare Part B coverage is described as “medical insurance” because it covers a wide range of more commonly used services.

These services include:

*Medical & Surgical from any doctor who accepts Medicare Patients no matter where those services are provided.

* Diagnostic tests and Labs that are done outside of a Hospital or Nursing Facility.

*Preventative services (mammograms, pap smears, flu shots etc…)

*Medical equipment(walkers, wheel chairs, oxygen, diabetic supplies etc…)

*Outpatient Services like those received in an Emergency Room, Clinic or ambulatory surgical facility.

*Chemotherapy and drugs ministered by injection

*Coverage for physical, occupational and speech therapies

*Mental Health Care

*Approved Home Health Services not covered by Part A

* Ambulance Services

You must pay a Premium to receive Part B services unless your income is low enough for these premiums to be covered by the state. If your income is above a certain level you are required to pay more premiums for Part B services.

In addition to a Part B premium you will also be required to pay for 20% of the services that you receive. This can add up to an overwhelming amount of money which is why many choose to purchase a Medicare Supplement Program.

MEDICARE PART C: Medicare Part C is offered by Private insurance companies and is called an Medicare Advantage Plan these plans provide managed care through HMO’s, PPO’s and Private Fee For Service contracts issued by insurance companies, these plans have become become a popular alternative to purchasing a Medicare Supplement. Medicare pays a fixed fee to the insurance company for each subscriber that chooses to enroll in an Medicare Advantage Plan in turn the insurance company designs a plan that is in line with CMS guidelines that covers both Impatient and Outpatient services.

 In addition to covering Part A and B services a Medicare Advantage plan may also cover Part D (drug coverage) as well. These plans are called MAPD plans and most of the time have little or no additional cost besides the Part B Medicare Premium. Medicare Advantage plans have become increasingly popular because they offer benefits that traditional Medicare does not cover. Services like dental, vision, over the counter medicine, trips to and from the doctor, meals etc…Depending on where you live there may be plans that offer to refund a portion or all of your Part B premiums to enroll.

MEDICARE PART D: Part D Coverage is for Outpatient Prescription Drugs and is issued by a private insurance carrier. Medicare’s drug benefit was added to the program in 2006 and has progressively gotten better since the passing of the Affordable Care Act.

Here are some important features to the Part D program that you should know about before you purchase a Part D plan.

*Coverage goes through four distinct phases during a calendar year. In each phase the drug may cost different amounts.

*Coverage must be selected from an array of different private plan options.

*Plans covers different drugs and no plan covers all drugs.

*Plans have different co-pays for each drug and these co-pays can vary from plan to plan.

*Plans may require you to get an pre-authorization before they will extend coverage for a particular drug, this is usually done through your primary care physician.

*Plans are allowed to change their costs and benefits once every year.

Drug plans can differ drastically in costs and benefits, that is why it is very important that you go over the plan benefits carefully before you choose your Part D Plan.