This first entry will be a general overview of Medicare and as the weeks progress, we will breakdown the coverage of each part of Medicare and its associated policies. We’ll look at all the options you have so you’re assured that you are covered and protected.
MEDICARE GENERAL OVERVIEW
Medicare is the country’s health insurance plan for people over 65 years of age and for other persons, under age 65, who have certain disabilities or conditions. Medicare has been around since 1965, when it was signed into law by President Lyndon B. Johnson. There have been several amendments to the original Medicare plan: once in 1972 and the most recent Medicare Modernization Act (MMA) signed into law by President George W. Bush in 2004.
Medicare is divided into four parts:
Part A is Hospital Insurance. It pays for inpatient hospitalization, skilled nursing care, hospice and some home health care. Part A is an element of the Original Medicare Plan. Part A is given to eligible citizens by the US government at no cost. You will be automatically enrolled in the plan to be eligible on the first day of your 65th birthday month. For example, if your birthday is August 29th, your effective date will be August 1st.
Part B covers doctors’ services, outpatient hospital care and some other medical services that are not covered under Part A. Part B also covers physical, occupation therapy and some preventive care services. Participation in Part B is voluntary and you’ll need to contact 1-800-MEDICARE for enrollment information. The US government subsidizes about 75% of the premium of Part B and the premium is $99.90 for 2012.
Part C is an HMO or PPO Medicare policy which provides the Medicare recipient with copays for services, no claims filing and may add services that are not covered by Medicare or Supplement policies such as eye exams, hearing aids, prescriptions or dental care. Medicare Advantage HMO products require that you receive your medical services by a participating provider, with the exception of emergent treatment. A PPO Med Advantage plan has all the advantages of the HMO provider network plus the option to go to a provider who is not in the network.
Part D covers prescription drugs and is a part of the MMA which was enacted in 2004. Members must sign up for a prescription drug plan which offers coverage in their local area. If you have a Medicare Supplement policy, you must have a separate Part D policy to cover your prescription drug costs. With a Medicare Advantage (Part C), often medication coverage is included in the Advantage plan.
In the coming weeks and months, we will continue to take a look at how Medicare works for you. It is our hope that this will help with some of the confusion of Medicare, Supplements, Advantage and Prescription Drug coverage (Part D). We encourage dialog and any questions you may have about the most complicated and confusing insurance policy you will ever have.
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