Medicare Health Insurance Basics

What Is Medicare?

Medicare is a Social Security benefit for which individuals age 65 and older or individuals under age 65 that have certain disabilities, such as permanent kidney failure, may be eligible. Essentially, the federally funded Medicare health insurance plans cover treatment of acute medical conditions or those conditions from which individuals usually recover. Medicare attempts to provide reasonably priced, quality health care to the segment of the population that generally lives on a restricted income. Medicare is provided in four parts, Parts A-D, and each part covers specific services. Most people eligible for Medicare are covered under the Original Medicare Plan. Individuals covered by this plan pay a portion of their health care costs as well as an additional premium, referred to as a deductible and coinsurance, for Parts B and D.

About Medicare Part A

Medicare Part A is commonly referred to as the Hospital Insurance and covers services considered to be medically necessary such as inpatient hospital care, critical access care, short-term care in skilled nursing facilities, hospice and home health care. Medicare usually does not pay for long-term care at home, in assisted living facilities or at nursing homes. Medicare Part A is free to most Medicare beneficiaries if the beneficiary or their spouse paid Medicare taxes while they were working. Even if an individual is not eligible to receive Part A free-of-charge, the individual may be eligible to purchase Part A coverage if they meet eligibility requirements.

About Medicare Part B

Medicare Part B is referred to as Medical Insurance, and Part B covers medically necessary services such as doctor and outpatient care. Part B does cover some preventive services. Additionally, some occupational and physical therapies may be covered by Medicare Part B. Unlike Part A, Part B coverage does require a monthly premium. While standard premium amounts do exist, premiums can be higher for some beneficiaries than others. This is because Part B premiums may be based on beneficiary income. It is important to remember that Part B is not a 100 percent insurance coverage plan, and beneficiaries will be responsible for the balance of expenses not paid by Medicaid and not all medical services are covered.

About Medicare Part C — Medicare Advantage Plans

Medicare Part C is generally called the Medicare Advantage Plan. Part C offers health coverage by private companies that are approved by Medicare. Health plan options include: Preferred Provider Organizations (PPO), Health Management Organizations (HMO), and Private Fee-for-Service. Medicare Part C still provides beneficiaries with services covered by both Part A and Part B. Part C coverage may offer additional benefits dependant upon the private company providing the coverage. Additionally, most Part C plans include prescription drug coverage and sometimes this will be an extra cost. See $0 Premium Medicare Advantage Plans

About Medicare Part D — Prescription Drug Coverage

Medicare Part D offers prescription drug coverage to Medicare beneficiaries. One of the goals of Part D coverage is to provide beneficiaries with lower prescription drug costs. This prescription drug coverage is provided by private companies that have been approved by Medicare. Part D coverage allows Medicare beneficiaries more access to the medically necessary medication that they need. Beneficiaries pay a monthly premium for this coverage, and Part D plans do vary in cost. The medications covered by each plan may vary as well. Part D may be added to the Original Medicare Plan (Part A and Part B). Most Medicare Advantage Plans already have Part D coverage. If not, Part D may be added to Part C coverage. See Medicare Part D Prescription Drug Plans

Medigap (Medicare Supplemental Insurance) Health Insurance

Medicare Supplemental Insurance (Medigap) is a supplemental health insurance plan designed to cover services for which Medicare only partially covers or does not cover at all. Essentially, this plan covers the “gaps” between what Medicare pays and the total expenses. It also helps to cover co-insurance, co-payments and deductibles. Medigap is sold by private insurance companies. Medigap policies may have prescription drug coverage, and beneficiaries are not allowed to join Medicare drug plans and keep the prescription coverage under Medigap. Click here for Medicare Supplemental Insurance Comparison

Choosing Medicare Health Insurance for Seniors

The Original Medicare Plan, or Part A and Part B coverage, is a federally managed fee-for-service plan. Beneficiaries can choose the doctor and hospital from which they would like to receive services. Monthly premiums, annual deductibles and co-payments for services are required. Prescription drug coverage, or Medicare Part D, may be added to the Original Medicare Plan. Many beneficiaries covered by the Original Medicare Plan find they also need the Medigap policy to help pay for services not covered by Part A and Part B.

Medicare Advantage Plans (Part C) provides Part A and Part B coverage, but this coverage is provided by private insurance companies that have been approved by Medicare. Because private companies provide this coverage, additional benefits may be available. Additionally, the amounts charged for various services may differ between providers. Part C plans may have networks, and the beneficiary will have to utilize the services of providers in the plan’s network. Prescription drug coverage is often included in this plan. Beneficiaries of Medicare Part C do not need to purchase Medigap coverage.

When choosing a Medicare health plan it is important to determine what is expected from the insurance coverage. It would be advantageous for beneficiaries to compare and select coverage based on the plan that will best meet their individual needs.

Joining, Switching, and Dropping Medicare Health Plans

Individuals may join a Medicare health insurance plan either 3 months before or 3 months after age 65. Medicare requires that once individuals enroll, they remain enrolled for the calendar year. The calendar year commences the date the coverage begins. Changes can be made in either health coverage or prescription drug coverage between October15 and December 7 annually starting in 2011. Individuals may dis-enroll from a Medicare Advantage Plan between January 1 and February 14 annually starting in 2011. Medicare enrollment periods

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