Part A Hospital Insurance
Part A hospital insurance pays for inpatient care as well as hospice benefits. In addition, limited home health care and short stays in skilled nursing facilities is covered. Like commercial policies, coverage is subject to deductibles, co-payments and limitations. The skilled nursing home benefit, for example, covers care only after a three-night hospital stay. Maximum coverage is 100 days per calendar year with days 11-100 carrying a co-insurance cost. For most people over 65 part A coverage costs nothing. The benefit is funded exclusively through payroll taxes. Some who qualify, but haven’t paid enough into the system to receive the benefit for free may have to pay a premium. Under Part A benefits are also available for select conditions for those under 65.
Optional Coverage From Part B
An optional medical insurance that covers a portion of doctor visits is Part B. In addition, it covers the following:
• Lab tests and x-rays
• Outpatient procedures
• Durable medical equipment and blood products
• Mental health services
• Ambulance service
Preventive care services must be medically necessary and a small deductible applies. The cost of premiums is based on adjusted gross income from two years prior and higher income recipients pay more
Part C Advantage Plans
Advantage Plans, known as Medicare Part C, are sold by private insurers as an alternative to traditional coverage. To enroll in this plan, you must be Medicare-eligible. These plans are organized and managed like commercial health insurance. They are required by law to provide at least the same benefits as the traditional Part A and B plans. Most include Part D coverage and additional perks. These include benefits for hearing aids, dentures and glasses. The lower cost and extras are attractive and a good value for some, but the trade-off is that rules for coverage are strict. You may have to choose an in-network doctor or hospital, and benefits tend to be tightly managed in order to control costs.
Prescription Drugs Covered by Part D
The portion of the plan that covers prescription drugs is called Part D. Plans are purchased from private insurers and are available to anyone enrolled in both Part A and B, or as part of a Part C replacement plan. Purchasing a Part D policy is not mandatory, but if you do not choose one during your initial enrollment period, you will pay a penalty to sign up later. Although plans are administered per federal guidelines, each company has their own policies for covered medications. In addition, premium costs and co-payments will differ.
Medigap and Standardized Plans
Insurance policies that pay expenses not covered by Part A or B are referred to as Medigap plans. These plans cover co-payments, deductibles and care received while travelling outside the country. These optional plans are offered by private insurers and are only available to Part A and B participants. A selection of standardized plans designated by the letters A, B, C, D, F, G, K, L, M and N is available to meet a wide range of needs. These plans vary by state and plans may change as federal and state laws evolve.
There is a specific window of time for enrollment in Medicare. You must sign up between October 15 and December 07 each year. Changes can be made only once annually. Therefore, it pays to make the best insurance decisions up-front. For those who are Medicare-qualified, but can’t afford the premiums, state-run Medicaid programs may pick up the cost. If the time is approaching when you or a loved one may be eligible and you still have questions, contact a local insurance agent or your state office for help.