What You Need to Know about Medicare

Turning 65 marks a major milestone in one’s life: Medicare eligibility. Although the federal insurance program is primarily associated with the retirement age, it is also available to young people with certain disabilities. It is best to enroll in the program prior to turning 65 so as not to suffer any penalty fees or delays in coverage.

Medicare coverage is based on three factors: federal and state laws; national coverage decisions made by Medicare on whether something is covered or not; and local coverage decisions made by companies in each state that process claims for Medicare (Source: www.medicare.gov).

Medicare is divided into different sections and covers services such as lab tests, surgeries, and doctor visits, as well as supplies considered necessary to treat a disease or condition. Benefits from both Medicare’s Part A and Part B are required when initially enrolling for coverage.

Part A– Hospital Insurance

This section covers in-patient hospital care, nursing facility care, nursing homes, hospice, and home health services.

Part B– Medical Insurance

This section covers services needed to diagnose or treat a condition and preventative care services. Clinical research, ambulance services, durable medical equipment (DME), mental health, and limited outpatient prescription drugs are covered under this section.

Part D– Prescription Drug Coverage

This section covers prescription drugs and can be obtained in one of two ways, either through Medicare Part D, or Medicare Advantage plans. You cannot be enrolled in both Medicare Part D and a Medicare Advantage plan at the same time. Each plan has its own list of covered drugs.

Medigap– Medicare Supplemental Insurance

Medigap plans cover part or all of the costs otherwise paid under Medicare Parts A and B, including deductibles and co-payments, according to Kiplinger’s Personal Finance Magazine. There are 10 Medigap plans and each one has standardized benefits with varying premiums set by the carrier.

Part C– Medicare Advantage

Medicare Advantage plans are offered through private insurance companies that contract with Medicare. The plan includes all the benefits of Parts A and B, and most plans include prescription drug coverage. The types of Medical Advantage Plans include:

  • Health Maintenance Organization (HMO) Plans
  • Preferred Provider Organization (PPO) Plans
  • Private Fee-for-Service (PFFS) Plans
  • Special Needs Plans (SNPs)
  • HMO Point of Service (HMOPOS) Plans
  • Medical Savings Account (MSA) Plans

To sign up for Medicare Parts A and B, call 800-772-1213, or visit www.socialsecurity.gov/medicareonly. For more information on Medicare plan options and to compare plan premiums, visit www.medicare.gov.

*This article is written for informational purposes only and should not be construed as providing legal advice.