Have you heard of Medicare? It is a government-sponsored health insurance program that provides coverage to people 65 and older, and some individuals with disabilities. Parts of Medicare explained will give you an overview of the various parts of Medicare.
If you’re not sure what it does or how to apply for it, this post will help explain how to get started! The benefits include hospitalization coverage for any illness or injury, medical care coverage including doctors’ visits, emergency care, mental health services, home healthcare services and more! Medicare explained in an easy to understand format is what this post is all about.
Medicare Explained in 4 Parts
The plan has four parts: Part A – Hospital Insurance; Part B – Medical Insurance; Part C- Comprehensive Medical Care Program (CMC); and Part D- Prescription Drug Coverage. Having Medicare explained in terms easy to understand will help you make a wise decision.
Medicare Explained: Part A – Hospital Insurance
Hospital insurance is a medical benefit that covers inpatient care. If you have to go to the hospital, Medicare will pay for all of your medically necessary services like room and board, nursing care, operating rooms, lab tests or x-rays, ambulance services, and other medical supplies.
Hospital insurance is beneficial so that you won’t have to cover medical expenses if you need extended hospital care. Part A helps cover inpatient hospital stays, hospice care & limited skilled nursing facility costs. It also covers home health services and durable medical equipment (DME).
Medicare Explained: Part B – Medical Insurance
Medical insurance is a supplemental part of Medicare that covers outpatient services like doctor visits, lab tests, x-rays and other diagnostic procedures. The plan also covers medically necessary items such as wheelchairs or walkers. Also included in Medicare Part B is durable medical equipment for home use by those with limited mobility because of age or disability.
As far as dental work, Part B of Medicare will cover only those dental procedures that are deemed necessary for medical treatment of another covered service. Routine dental expenses such as cleanings and fillings are not included in Part B coverage. You will need a Medicare Advantage plan or other dental insurance for routine dental care.
Medicare Explained: Part C – Medicare Advantage Plans
This is a plan that is a private insurance option that helps you get all of your benefits. These plans can cost a monthly premium and may have co-pays, but often the plan will provide additional services like vision and dental coverage. They “wrap around” traditional Medicare coverage.
Some benefits include prescription drug coverage, routine dental care for adults, vision services or even gym memberships! These plans may offer lower costs than original-fee-for-service (FFS) Medicare. Still, carefully review them, to make sure they’re right for you since there may not always be a provider network available in your area.
Comprehensive Medical Care Program (CMCP)
Comprehensive Medical Care Program (CMCP) is an advantage plan that can provide all the benefits you require, including co-pays and a monthly premium. While you may be subject to certain limitations for services provided under this program, CMCP offers flexibility in your healthcare choices.
Flexibility means more freedom from traditional FFS plans. The Comprehensive Medical Care Program is not available everywhere, so do some research before enrolling! Having Medicare explained by a licensed professional will greatly aid you in making the best choices.
Prescription Drug Coverage
Forty per cent of seniors don’t have prescription drug coverage because they either don’t think they need it or can’t afford it. However, 30% of those over age 65 take five or more medications daily–without adequate insurance coverage, these expenses could quickly become unmanageable. As a result, people often stop taking their prescriptions as directed, resulting in potentially dangerous issues.
To prevent this from happening, an Advantage plan or Medicare Part D is a great way to ensure coverage. If you have a chronic condition that requires ongoing medication, then Part D is well worth considering to help cover the high cost of needed medication.
Medicare Explained-Medicare Part D
The Prescription Drug Plan (PDP) is a voluntary service provided through private insurance companies offering prescription drugs at an affordable cost to help you manage chronic conditions. This plan covers both brand names and generic medications.
This part has its own formulary (list of covered drugs) and tiered co-pays. If you’re not sure which plan is right for you, the Prescription Drug Plan Finder can help! Part D is optional and comes as a stand-alone plan or as parts of a Medicare Advantage Plan.
Applying For Medicare Part D
Part D can help with the cost of prescription medications, both brand name and generic drugs (and you don’t have to enroll in this coverage when applying for Part C).
There are four different levels to choose from:
- Low-Income Subsidy (LIS)
- Alternative Coverage Options (ACO)
- Employer Group Waiver Program (EGWP)
Each one has its own premium fee, which depends on your income level.
Alternate Coverage Option
An alternative coverage option, or ACO for short, is a type of plan offered by the federal government as an incentive to competition within the private insurance market. This program allows individuals and families to seek out other types of plans that may better fit their needs.
The Affordable Care Act (ACA) introduced this concept in order to help people find affordable healthcare options while also preventing “free-riders” from taking advantage of taxpayer-funded programs such as Medicaid.
Affordable Care Act
The Affordable Care Act has two different parts: Employer Group Waiver Program (EGWP), which works similarly but provides help only if you have been working for at least 30 hours each week with no benefits through your employer. The second part is the Special Enrollment Period (SEP) which is a time of the year when you can apply for it without having to wait.
Special Enrollment Period-Medicare Explained
The SEP period begins at different times throughout the year, but it usually starts between October fifteenth and December seventh. If you are eligible during that window, then there will be coverage effective January first; if not, your next opportunity would start on April fifteenth, which could also provide benefits by July first.
The particular dates depend upon what day you sign up, so plan as much as possible in order to avoid missing out – nobody wants their medical services interrupted because they didn’t realize how long it takes or weren’t able to gather all required documentation within the allotted timeframe!
How Do I Apply?
When applying, you must provide personal information, including your Social Security number. You must also show citizenship or lawful presence status and proof of income. It may be a good idea to provide your birth certificate, driver’s license or passport as well. Try to have all required paperwork ready before beginning the application process.
List any dependents on your tax return as this may affect premiums (and possibly eligibility). This is because total yearly household income affects your rates. The amount varies depending upon whether everyone listed has their own policy. You may also want to look into a family plan.
Medicare Penalty Fee
You can sign up anytime during the year. If you miss your initial enrollment period, there may be a penalty that increases yearly until it reaches 100% of the base premium. There could also be an extra amount based on how many years have passed since your original date of eligibility.
You cannot enroll in Part A or B unless you already receive retirement benefits from Social Security. And last, all parts require proof of US citizenship. Along with documentation to prove age – usually via a birth certificate or passport – and documentation for social security number.
Benefits of Medicare-Medicare Explained
Medicare provides services for people age 65 and older. Under the age of 65, Medicare is available to people with certain disabilities. To list a few: chronic kidney disease (CKD), amyotrophic lateral sclerosis (ALS), end-stage renal disease (ESRD); those who receive Social Security Disability Insurance benefits because they have ALS or ESRD and American Indians & Alaska Natives.
Many people depend on this program to provide them with medications, doctors’ appointments and other healthcare services; without it, they could not afford such services, which can lead to serious health problems.
Another benefit of this is that it can help pay for certain healthcare services that are not covered by Medicaid. Such types of services include transportation to and from care facilities, certain types of therapy, eyeglasses, hearing aids, and more.
For people who require long-term care (LTC), it may provide financial help with LTC insurance premiums & skilled nursing facility costs. These services are available through plans, which you can talk about during your next doctor visit.
Why Do I Need Medicare?
It is a valuable resource for anyone who needs help to pay their medical expenses. As a citizen approaching the senior ages, it is important to learn about this service and what it means to you. Getting enough information about the various parts and its benefits will help you prepare for your future.
It can be a key factor in ensuring that you have access to the healthcare services necessary for your well-being. Having every part of the population understand all the parts to these services is an immediate guarantee of everyone’s basic access to care!
If you don’t understand or still have questions, please have Medicare explained to you by a trusted health insurance agent.