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Understanding Your Medicare Benefits

Understanding your healthcare benefits has never been an easy task. Once you enter the world of Medicare, it doesn't get any easier.

Medicare is the federally funded health coverage plan available to adults ages 65 and older. You can enroll during the 3 months before turning 65 and for 7 months after, or during the annual enrollment period.

Medicare has different parts, called Medicare Part A, Part B, Part C, and Part D. Each offers different types of coverage.

Below is an overview of the different Medicare parts and what they offer.

Medicare Part A

Part A is included in your Original Medicare coverage. It covers care in a hospital or inpatient facility, skilled nursing care, hospice, and home health services. Generally, you can choose the healthcare providers and hospitals you prefer. Part A doesn’t cover your deductible, which is the money that you must pay before your coverage will start to apply. Part A also doesn’t cover your coinsurance, which is the percentage of costs you must pay after your deductible has been met. You will either pay for your deductible and coinsurance yourself. Or you can get an additional Medicare plan to cover those costs not included in Part A. This additional plan is called a supplemental plan.

Medicare Part B

Part B also is included in your Original Medicare coverage. It covers your medical care, including healthcare provider appointments and preventive care, home health as well as any medically necessary supplies, such as a wheelchairs, walkers, hospital beds, and other equipment. Although costs vary, usually you pay a monthly premium, or fee, for your Part B coverage. Your deductible still applies for healthcare provider visits.

Medicare Part C

Part C combines both Part A and Part B, so it covers both hospital care and care at the healthcare provider's office. But Part C is also called a Medicare Advantage Plan. It is not part of Original Medicare, and you have to pay an extra monthly premium for it. Medicare Advantage programs are offered through private insurance companies but must follow rules set by Medicare. In most cases, you will have to use the hospitals and healthcare providers within the insurer's network. Each Medicare Advantage plan has different costs and rules and each plan can charge different out-of-pocket costs. The Advantage plan you select will determine if you need a referral to see a specialist and if you can only go to certain healthcare providers, medical suppliers, or treating facilities for nonemergency or nonurgent care.

Medicare Advantage Plan rules can change each year. Advantage Plans offer the same coverage as Parts A, B, and D, sometimes with lower copays and some coverage for vision and dental care. However, do your research before enrolling, especially if you live in a rural area, where the network of approved providers can be limited and wait times for appointments long. In addition, if you have complicated health needs, Medicare Advantage Plans typically require pre-authorization and care from a limited number of providers.

Before making a selection, give careful consideration to your finances and health needs.

Medicare Part D

This part covers your prescription drugs. You must have Part A and Part B or Part C to enroll in a prescription drug program. All Part D plans are offered through private insurance companies. They have varying rates and coverage for different drugs. If you have a Medicare Advantage plan, you will probably need to choose a Part D plan from the same insurance company.

Supplemental insurance

Supplemental insurance, also called a Medigap plan, is for people who don't qualify for Medicare Part C/Medicare Advantage plans. This is designed to cover any gaps in your coverage for costs that are not paid for by Original Medicare. It’s sold through private insurance companies. It has varying costs and rules, depending on the plan and the insurer.

Many different plans are available, with many factors to consider. Before you choose a plan, make sure it will meet your needs. It should cover your specific prescriptions, as well as care from your preferred healthcare providers and hospital.

People on limited incomes may qualify for additional assistance and lower premiums for Medicare benefits. To find out more about Medicare plans, enrollment periods, and cost-saving choices, visit the Medicare website @ www.medicare.gov.