Understanding Medicare: The A B C & D's of Coverage

UNDERSTANDING MEDICARE: A B C & D ‘ S OF COVERAGE

At some point in your life you are going to have questions about Medicare, if you’re a millennial, you will likely have some exposure to it at some point when your parents decide to retire, or perhaps you have a loved one who will be eligible in the near or distant future due to illness. I’m going to give a brief, not super confusing explanation about the A B C’s & D’s of Medicare.

What is Medicare? Medicare is a federal benefit for people who worked and or who became disabled under the SSA criteria and are now eligible for this insurance. Medicare is a form of health insurance that provides coverage for medical. There are different types of Medicare and often you will hear things like, Part A, B & D when it comes to this benefit.

Medicare Part A

Covers a portion of a person’s hospital stay but not all. It only covers 80%.
Short term home health care benefits, however you must require a skilled need more specifically you have some sort of illness that needs monitoring by a registered nurse, physical or speech therapy services. Note that this benefit is temporary and this is in terms of anywhere from two to six weeks maximum in MOST cases.

Medicare Part B

Doctor’s visits, however not in full only 80% of that is covered under Medicare.
Durable medical equipment, only certain kinds, there are very few that are covered.

o Medicare Part B: premiums due monthly and are taken out of the recipients Social Security Check.

TIP: Must enroll once you become eligible otherwise you will incur penalty fees. If you are retiring, find out if your employer offers coverage for Part B benefits. `
Some employers i.e. retired board of ed teachers (at least in NY) can get reimbursed annually for fees taken out for their part B benefits.

Medicare Part C

This specifically relates to individuals who are enrolled into a Medicare Advantage Plan. There are advertisements for these plans all over including pharmacies. These types of plans replace traditional Medicare and have a specific network of providers that normally requires some sort of pre authorization.

Medicare Part D

Covers medication for recipients of Medicare. Note that for many people with this benefit there can be a lot of pocket costs at some point especially if you’ve reached the donut hole. This basically means that you have reached a specified deductible amount where your Part D plan will no longer cover the expenses of drugs resulting in out of pocket costs for the consumer. Some states have specific plans to help with some of these costs. Check your local state Dept of Health for details. New York State residents may be eligible for EPIC.
When it comes to drug coverage some people have this mentality that they don’t need it, especially if they aren’t taking any medications at the time that they become Medicare eligible. I can’t stress this enough but please reconsider unless you are eligible for coverage through an alternate means i.e. employer plan or a union benefit. Here’s why I, let’s say when you first became eligible for Medicare five years ago you were healthy and had no medical problems, if you did not pick a Part D drug plan you will be penalized by Medicare because of it, unless you can show that you had credible coverage.

Open Enrollment

This is the time of year where Medicare recipients are eligible to switch their current health insurance plan to either a Medicare Advantage plan or traditional Medicare. It is also the time of year where you can switch a drug plan to an alternative one. Open enrollment begins October 15 through December 7. Once you pick the plan the consumer is eligible for coverage January 1 of the following year.
Jan 1 – March 31

Recipients of a Medicare Advantage plan that want to change is allowed to do so once during this time period which would be effective the first of the month following the request.

Medicare Savings Program

Available for people who are recipients of Medicare who are low income, where the state agrees to pay specific medicare premiums, deductibles, coinsurance and copayments. Every state has different guidelines. You must connect with your local Medicaid office to see if you qualify.

Have additional questions about Medicare? They have a guidebook that they send every year to Medicare recipients that is very user friendly. If you need specific questions answered reach out to Medicare Rights. They are a good resource that offers a lot of insight and advice about all things Medicare.