To Be a Knowledgeable Consumer of Medicare, it is Important to Familiarize Yourself with the Four Different Parts Designated as A, B, C, and D.
Are you new to Medicare or maybe a long time beneficiary? There is always something to learn about this government health insurance program, which can be quite complicated even for someone who’s had a lot of experience with it. Simply put, Medicare is a health insurance provided by the government for senior citizens and persons with disabilities. This particular insurance covers the people in these two mentioned groups for all their health care needs. Medicare takes care of hospital care, visits to the doctor, medical tests, and prescription drugs. It is estimated that there is one out of seven Americans enrolled to Medicare, which means that this is the biggest health insurance program in the country.
Medicare has been operating for a little under 50 years now and anyone over 65 and everyone with kidney failure can sign up for this plan if they have Social Security. The number of insured individuals is continuously rising as more and more baby boomers hit the age of 65. The estimates are that Medicare members will reach 50 million in the year 2016.
Medicare has four parts designated as A, B, C, and D. There is also extra coverage that participants can purchase which are called Medigap plans. Medicare Part A and B are collectively called the Original Medicare coverage or traditional Medicare, and are entirely run by the government. People who reach the age of 65 are automatically enrolled into traditional Medicare, unless they elect to enroll in a different Medicare Part.
Medicare Part A covers inpatient care in hospitals or skilled nursing facilities. It also includes both hospice and home health care services. If you have been paying your Medicare taxes when you were working then you will not have to pay the monthly Part A premium, otherwise it will cost you around $450 per month. You may also be asked to pay a part of the cost of your health care. In fact in 2012 participants will have a policy deductible of roughly $1,500 for every hospital stay up to 60 days during a year.
Medicare Part B covers necessary health services including doctor appointments, outpatient care, medical tests, and durable medical equipment. The monthly premium for Part B is $99 a month and it can go higher if you have an individual income of over $85,000, or if you and your spouse have a combined income of $170,000. You will also have to pay the first $140 of your medical expenses and shoulder 20 percent of most of your costs after that. Some services would require a higher cost such as mental health-office visits, which would require you to pay 45 percent of the cost.
Medicare Part C is also known as the Medicare Advantage plan. This program lets participants claim their Medicare benefits through a private health care plan. Medicare Advantage covers all the services covered under Medicare Part A and B, plus the participant will always have emergency care coverage. Hospice care however would still be covered under Original Medicare. Since Medicare Advantage is offered by private insurers, these companies would typically offer additional services and benefits like vision, dental, podiatry, hearing, chiropractic, as well as health and wellness programs. Some of them would even cover prescription drugs or Medicare Part D.
A participant can only enroll to a Medicare Advantage plan if they have already signed up for Medicare Part A and B. Expect to pay a premium for this plan in addition to the premium to be paid for Medicare Part B. There might also be deductibles, co-payments, and co-insurance for services like doctor visits, tests, medications, and selected treatments. Perhaps the most popular Medicare Advantage plans are HMOs because they have the cheapest premiums, though participants would be restricted in terms of the doctors and hospitals they can see and go to.
Medicare Part D is the newest addition to the government-sponsored health program, which was added in 2006. These plans help pay for drug coverage and are also offered through private insurers. Participants have the option to get a stand-alone Part D plan or to roll it into their Medicare Advantage plans. There will be a monthly premium, a deductible, co-pay, and co-insurance for their medication. It is in this program where the “donut-hole” concept applies. This is a gap in coverage where participants will have to shoulder the cost of their drugs one hundred percent. For the year 2013, participants will fall through the donut hole when the cost of their prescription drugs reaches $2,970.
Since Medicare does not cover all of the participant’s health care costs, they can purchase Medigap Supplemental Insurance that runs from Plans A to N. These plans are sold through private insurers and are designed to bridge the gaps in the health-care costs. The plans begin with the basics at Medigap A and offer more and more coverage as you go down the alphabet.