Choosing your Medicare benefits can be very confusing whether you are a seasoned recipient or you are preparing to enroll for the first time. Your Medicare choices should involve some serious thought before you make your decision.
Medicare is a health insurance plan for individuals who are age 65 and a U.S. citizen. If you have worked 40 quarters (10 years) you are entitled to Medicare.
If you are an individual with end stage renal disease, on hemodialysis or kidney transplant recipient, you also qualify for Medicare benefits.
Once enrolled, you do not have to sign up for Medicare annually but you can make changes to your choices each year, during open enrollment. Open enrollment occurs each year between October and December. New coverage begins each year on January 1. Routinely, Medicare pays 80% and you are responsible for the remaining 20%.
There are two main types of Medicare – Original and Medicare Advantage.
Medicare part A (hospital insurance) is part of the original Medicare plan. Medicare part A pays for inpatient hospital stays, skilled nursing facility care, hospice and home health care. Skilled nursing facility and rehabilitative services are provided on a continuous daily basis in a skilled facility. You have your choice of doctors, hospital or other providers that accept Medicare. Medicare Part A is free. You or your supplemental insurance will pay the required deductible, co insurance or co-pays.
Medicare part B (medical insurance) pays for services from doctors and other health care providers , outpatient services , home health care, durable medical equipment and some preventative services. These preventative services may include a yearly wellness visit, mammogram, colorectal screening for colon cancer, flu shot or a prostate cancer screening.
If you elect to purchase Medicare part B, you will pay a monthly premium. First time enrollees have eight months to decide whether to purchase part B, before penalties occur. Your cost for part B will depend on your choice of doctors and other care providers. If you don’t see doctors that accept Medicare assignment, you will pay more for your Medicare part B.
Assignment means that your providers, doctors, or suppliers agree to or are required by law to accept the Medicare approved amount, as full payment for services. This does not mean that your co-pays, co-insurance, deductibles or 20% are no longer your responsibility.
In order to have prescription drug coverage with original Medicare, a Medicare D plan must be chosen. Medicare D helps cover the cost of prescription drugs. Medicare approved, private insurance companies offer Medicare D plans.
If you choose original Medicare, you may want to consider a supplemental insurance called Medigap. Cost may vary by policy and company. Medigap is an extra health insurance that helps pay for the hospital and medical costs not covered by original Medicare.
The alternative to an original Medicare is Medicare part C or the Medicare Advantage plan. You must join this plan, if you don’t join the plan, you will be enrolled in original Medicare. Medicare part C usually includes all benefits covered under Medicare A & B. Medicare Advantage plans include prescription drug coverage. Many of these plans include extra benefits that are not offered by original Medicare. In most cases you must accept the drug coverage plan included with the plan.
If you choose a Medicare Advantage plan, you are not eligible for a Medigap supplemental plan to help pay out of pocket expenses.
When making your Medicare decision, you should consider the cost and coverage you need. Do you use prescription medications? How many prescription medications do you use? Are you satisfied with you current doctors or is it time for a change? Do you have other healthcare coverage?
Remember, the choices you make are in effect for an entire year. The information included in this article is not all inclusive and may not apply to your specific needs. If you have questions or need additional information, contact Medicare at 1-800-833-4227.
Marcia L. Jackson, case manager, clinical operations, is a registered nurse with Care Improvement Plus in Baltimore, MD.