WHAT IS MEDICARE?
Medicare is a federal program offered to individuals 65 years and older, certain younger people with disabilities, and people with end-stage renal disease. Understanding what Medicare is, what it covers, and deciding what plans to choose can be daunting. It may even be confusing for those who have already chosen their Medicare plans.
To help you understand the different types of coverages and which may benefit you most, you need to understand each plan and what it entails. Medicare plans cover different services, including: inpatient hospital stays, outpatient services, skilled nursing care, prescription drugs, and medical equipment. There are four types of Medicare plans: A, B, C, and D.
Medicare Part A
You can think of Medicare Part A like hospital insurance. It helps cover inpatient care and services like hospital stays, nursing care, some home health services, skilled nursing care, and hospice care. For eligibility, you have to be admitted to the hospital and stay overnight for three midnights. Many who qualify for Part A will discharge to a short-term rehabilitation facility, and receive 24-hour nursing services and a regimented therapy program to assist in getting stronger and healthier for their return home. If you qualify for Part A, it will pay up to 100 days of your stay if you’re progressing toward the treatment goal and the services are justified in the therapy team’s documentation.
Medicare Part B
You can think of Medicare Part B like medical insurance. It helps cover outpatient services such as doctor visits, therapies, procedures, and some medical equipment and adaptive devices. Part B, has a minimal deductible set by the government you must meet before your benefits kick in. Part B will only pay up to 80%, leaving you responsible for the remaining 20%. Many choose a supplemental insurance to help cover the remaining 20%. Therefore, when selecting a supplemental insurance, check to see how it works in conjunction with Part B.
With Medicare B, three midnight stays at a hospital are not required for eligibility. You are eligible anytime a service is needed or necessary. A doctor’s signature to evaluate and treat a condition with a specific discipline will suffice for Part B to kick back in and pay for the services.
Medicare Part C
You may know Medicare Part C as a Medicare Advantage Plan. These plans are approved through Medicare and are required to offer the same coverage as Medicare Part A and Part B minus hospice care. They may even offer more services than A & B such as dental, vision, and prescriptions. Advantage plans are offered through private insurance companies. Therefore, you pick your own coverage through the insurance companies versus the government picking it for you. Every month, Medicare pays the private insurance company a fixed amount, and the insurance company covers your costs according to rules set by Medicare.
When choosing this plan, you are restricted to health care professionals and providers set by the insurance company, your premiums can change yearly, and your coverages can be dropped.
Medicare Part D is a prescription drug coverage. If you select going with Medicare Part A & B, Part D would be a separate plan. If you choose Part C, prescriptions coverage may be included.
Like every insurance plan, there are pros and cons to each so take the time to understand what each plan entails and match the coverage to your personal needs. You will thank yourself in the long run!
For more information and details on Medicare, visit medicare.gov.
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