Medicare is federal health insurance meant to “care” for people aged 65 and older, those who suffer from Chronic Kidney or End State Renal disease, ALS or Lou Gehrig’s Disease, and under certain circumstances those receiving Social Security Disability Benefits.
The 4 Parts Of Medicare
The Original Medicare plan consisted of two parts: A & B.
1. Medicare Part A Is For Hospital Coverage
Inpatient Hospital Care:
This includes all care you receive after being admitted into a hospital by a physician. Medicare covers up to 90 days each benefit period in a general hospital. In addition, you receive 60 lifetime reserve days. It also covers up to 190 lifetime days in a Medicare-certified psychiatric hospital.
Skilled Nursing Facility Care:
Medicare covers your room, board, and certain services provided in a skilled nursing facility. This includes medications, tube feedings, and wound care. It covers up to 100 days each benefit period. To qualify, you must have spent at least three consecutive days in the hospital within 30 days of admission to a skilled nursing facility and must have needed skilled nursing or therapy services.
Home Health Care:
Though it is normally covered by Part B, Part A coverage will kick in if you have spent at least three consecutive days as a hospital inpatient within 14 days of receiving home care. Up to 100 days of daily care are covered or an unlimited amount of intermittent care.
Hospice Care:
Hospice care is covered for as long as your provider certifies it is necessary.
2. Medicare Part B Is For Outpatient Medical Coverage
Provider Services:
Services deemed medically necessary are covered under Part B.
Durable Medical Equipment:
Equipment that serves a medical purpose, able to withstand repeated use, and appropriate for home use, is covered.
Home Health Services:
If you are homebound and need skilled nursing or therapy care, you’re covered under Part B.
Ambulance Services:
If you are homebound and need skilled nursing or therapy care, you’re covered under Part B.
Preventative Services:
Outpatient physical, speech, and occupational therapy services are covered as long as they are administered by a Medicare-certified therapist.
X-Rays And Lab Tests:
All doctor ordered x-rays and lab tests are covered.
Chiropractic Care:
Only when medically necessary to fix subluxation of the spine. Certain prescription drugs: Certain drugs such as immunosuppressants, select anti-cancer, select antiemetic, select dialysis, and other typical drugs administered by a physician.
3. Medicare Parts C & D
In 1997, Congress passed a law to reduce the financial strain on Medicare funds and provide Medicare beneficiaries with a variety of new health plan options. The new options are available through Medicare Parts C & D.
Medicare Part C:
Medicare Part C, also known as Medicare Advantage, is a private health plan provided by insurance companies contracted with the federal government. You will still be enrolled in Original Medicare (Part A and B), however Medicare Advantage plans may offer certain benefits that Original Medicare doesn’t cover, such as:
- Dental coverage
- Vision coverage
- Caregiver Counseling and Training
- Housekeeping
- Prescription Drug Coverage
Medicare Part D:
Part D is prescription drug coverage. This covers most outpatient prescription drugs. An individual can enroll in Part D if the individual has Parts A & B and lives in the plan’s service area. Part D is offered through private insurance companies as either a stand-alone plan or as a set of benefits included with a Medicare Advantage Plan. Each Part D plan has a list of covered drugs. If the drug you need is not on the list of covered drugs, you are allowed to request an exception, pay out of pocket, or file an appeal.
Each plan must cover all drugs in the following categories:
- HIV/AIDS treatment
- Antidepressants
- Antipsychotic medications
- Anticonvulsive treatments for seizure disorders
- Immunosuppressants
- Anti-cancer drugs (unless they are being covered under Part B)
- Most vaccines are also covered under Part D unless they are already covered under Part B.
Once you qualify for Medicare, you can apply for Original Medicare, Medicare Part A & Medicare Part B, at your local social security office or their website. Medicare Parts C & D you must enroll in.
But what if Medicare is still not covering all of your needs?
4. Medicare Supplement Plans
Medicare Supplements, also known as Medigap policies, are sold by private insurance companies to help you cover the out-of-pocket costs left behind by Medicare. When you have a Medigap policy, Medicare pays up to its limit on your medical expenses. Then, your Medicare Supplement plan will then kick in up to its limit. That limit usually is able to pay off the remainder. However, that will depend on which policy you select.
There are 10 standardized Medicap plans, which have a letter designation of A, B, C, D, F, G, K, L, M, or N.
How We Can Help
Medicare can be confusing. The best thing you can do is have a licensed Medicare Agent, like the team at ATIG, help you determine the coverage you need and find the best policy for you. We work directly with health insurance companies so our advisors can help you compare and enroll in coverage—at no additional cost to you. You pay only for the coverage you choose. Contact us today!
Medicare Enrollment Periods
Initial Enrollment = 7 Months In Total
It includes the three months before your 65th birthday, the month of your 65th birthday, and the three months after your 65th birthday. If your birthday is on the first of the month your enrollment period will begin one month early. For example: if your birthday is October 1, your enrollment period will begin June 1 and your Medicare will begin one month early as well — September 1. During your initial enrollment period, you can enroll in Original Medicare (Part A and B), Medicare Advantage plan, or Medicare Part D.
Open Enrollment
Once you are enrolled in Medicare Part A and B, there is a six-month open enrollment period for Medigap (Medicare Supplement) plans. This window begins with your Part B effective date and is a one-time election period.
