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Understanding Medicare
Need-to-Know Information for Navigating Your Federal Healthcare Options
The federal health insurance program Medicare is complicated but not impossible to understand. The program does have numerous parts and add-ons and the details of your selected policy can change from year to year, as can the premium.
Medicare itself offers comprehensive information at Medicare.gov; publications you can download or have mailed to you; toll-free numbers for your questions; and Medicare counselors in a town near you who can walk you through the entire process by phone. Because this information is subject to change, your best source for information about Medicare is the federal Centers for Medicare & Medicaid Services. But before you make contact, here’s a quick overview of Medicare – what it is, its parts and how those parts work together or not – so you know what specific questions to ask.
The Basics
Medicare is a federal health insurance program for people who are 65 years old or older. Some people with certain disabilities or diseases qualify for Medicare before they reach 65 years of age.
Medicare Parts
Medicare is available in four parts – A, B, C and D – each with its own level of services. Additionally there is Medicare Supplement Insurance, or Medigap, which is not Medicare but a private policy that works with your Medicare policy to supplement your healthcare costs.
Medicare Part A, in general, covers hospitalization, skilled nursing facility care, hospice care and some home-health services. This part is offered through the federal government with no premiums for most American citizens if they or their spouses paid Medicare taxes for a certain amount of time while working.
Medicare Part B pays for medically necessary services, mental health services, physician’s services, outpatient care, medical supplies,
durable medical equipment, ambulance services and some preventative screenings and services. This part is offered through the federal government and is combined with Part A. Part B does have premiums.
Medicare Part C is also known as Medicare Advantage Plans. These plans are offered through private insurance companies and premiums are charged. These companies contract with Medicare to provide Medicare A and B benefits plus benefits and services not covered under A and B. They may offer extra coverage, like vision, hearing, dental or health and wellness programs. Also, many Part C plans offer prescription drug coverage (so if you have your Medicare through Part C, you won’t need Medicare Part D). With Medicare Part C, you typically are part of a Health Maintenance Organization (HMO), a Preferred Provider Organization (PPO), a private fee-for-service plan, a special needs plan, or a Medicare Medical Savings Account (MSA) Plan.
Medicare Part D covers prescription drugs. It is an add-on to Parts A and B. As with Part C, Part D is offered through private companies approved by Medicare and there is a premium. Be aware that there is a penalty for late enrollment.
Supplemental Insurance
Medicare Supplement Insurance, or Medigap policies, are sold by private insurance companies and are meant to supplement Original Medicare, also known as Parts A and B. Medigap policies help pay some of the health care costs that Medicare doesn’t cover, like copayments, coinsurance and deductibles. Some Medigap policies also cover services that Original Medicare doesn’t cover, like medical care when you travel outside of the United States.
Newer supplemental policies do not include prescription drug coverage. To obtain such coverage, you need to sign up for Medicare Part D or a supplemental plan with drug coverage. Note that if you have Medicare Advantage Plan (Part C), it is illegal for a company to sell you a Medigap policy. You will need to choose whether Medicare Advantage Plan (Part C) or a supplemental policy best suits your needs.
The Medicare parts you choose are highly specific to your own unique situation. One starting point for figuring out what type of Medicare coverage is right for you is the questionnaire at Medicare.gov/ MedicareCoverageOptions. Our Medicare Resources section also has resources that can help you make informed choices so you can get the healthcare coverage that best fits your individual needs.
STATE MEDICARE RESOURCES
In North Carolina, learn more about Medicare, supplemental policies and more at the N.C. Dept. of Insurance at
NCDOI.gov/Consumers/Medicareand-Seniors-Health-InsuranceInformation-Program-SHIIP.
In South Carolina, learn more at the S.C. Dept. on Aging at Aging.
