Guest blog post by B. Kern
Medicare, the federal health insurance program for people aged 65 and older, can often seem like a maze of options and choices. With various parts and plans, understanding Medicare can be daunting. Here, we’ll break down the basics of Medicare to help you navigate its intricacies.
Medicare Choices
MEDICARE PART A
Medicare Part A primarily covers hospital expenses, including hospital stays, skilled nursing care, hospice, and home health-care services. While you may encounter various deductibles, coinsurance, and copayments, you typically earn Part A by paying Medicare taxes for 10 years (or 40 quarters) during your working years. If you haven’t earned Part A, a premium will be required.
MEDICARE PART B
Medicare Part B encompasses services that treat illnesses or conditions. This includes doctor’s office visits, lab work, x-rays, outpatient surgeries, and preventive services like cancer screenings and flu shots. Additionally, Part B covers medically necessary durable medical equipment, such as wheelchairs and walkers. Most individuals pay a premium for Part B. It’s worth noting that even if you’re enrolled in a Medicare Advantage plan that offers both Part A and Part B benefits, the Part B premium remains applicable.
MEDICARE PART D: Prescription Drug Plans
Original Medicare doesn’t extend its coverage to prescription drugs. However, Medicare Part D, which is optional, can be invaluable if you require medications. If you don’t enroll in Medicare Part D when first eligible, you may face a late-enrollment penalty. This coverage can be obtained either through an independent Prescription Drug Plan (PDP) or a Medicare Advantage Plan that includes prescription drug coverage.
Medicare Supplement Insurance Plans
Often mistaken for Advantage Plans, Medicare Supplement Insurance Plans work in tandem with original Medicare. Any caregiver that accepts Medicare will also accept a Supplement. Typically, Medicare covers 80% of the benefits, and the Supplement covers the remaining 20%. It’s crucial to understand that Supplements do not include Prescription Drug Coverage (Part D, PDP). Failing to get a PDP when first eligible can result in penalties, although exceptions exist. While the cost of Supplements may increase over time, the coverage remains consistent.
Medicare Advantage Plans
Also known as “Part C” or “MA Plans,” Medicare Advantage Plans are an alternative to Original Medicare, offered by private companies approved by Medicare. Enrolling in a Medicare Advantage Plan means you still have Medicare. These bundled plans usually encompass Medicare Part A, Part B, and often Part D.
Medicare Prescription Drug Plans (Part D)
These plans, sometimes referred to as “PDPs,” add drug coverage to Original Medicare and some other Medicare plans. Each plan has a unique list of covered drugs, known as a formulary. Many plans categorize drugs into “tiers,” each with a different cost. Generally, drugs in lower tiers are less expensive than those in higher tiers. If a required drug is in a higher tier, you or your prescriber can request an exception for a reduced copayment.
Conclusion
Understanding Medicare’s various parts and plans is essential for making informed decisions about your healthcare. While this overview provides a foundational understanding, the intricacies of Medicare can still be challenging to navigate.
Bruce Kern, along with Marcia Kern, run Premier Benefit Services, an independent insurance agency specializing in Medicare and other insurance services. With a mission to build lasting client relationships based on trust, wise counsel, and clear communication, Bruce and his team are dedicated to helping clients navigate these uncharted waters. For more information about Premier Benefit Services, visit https://premierbenefitservices.com/, or call Bruce and Marcia at 973-628-0694.