Understanding Medicare

Medicare was established by the federal government as a nation-wide health insurance program that provides health coverage to those who are 65 years of age or older, as well as individuals stricken with certain disabilities under the age of 65. Medicare also covers individuals with ESRD (otherwise known as End-Stage Renal Disease, ESRD is a disease in which those affected suffer from permanent kidney failure requiring either dialysis or a kidney transplant). Medicare coverage is divided into four major components.

Medicare’s four major components are:

Medicare Part A
Medicare Part B
Medicare Part C
Medicare Part D

Medicare Part A:

On the first day of the month that you turn 65 years old you are entitled to receive your Medicare Part A benefits. Generally, when it comes to Part A, you will not pay a premium under the pretense that either yourself or your spouse paid into Medicare taxes for at least 10 years of your working life.</p> <p>Most individuals are automatically signed up for Medicare Part A benefits. If an individual isn’t able to meet prerequisites to automatically receive Medicare Part A, there is a chance that they can still obtain Part A coverage by paying a monthly premium.</p> <p>If you already happen to be retired and receive Social Security benefits or receive benefits from the Railroad Retirement Board (RRB), you are automatically enrolled in Part A coverage. If you are still working, you may very well need to enroll for Part A coverage (even if you are eligible to your Part A benefits at no premium cost).

Services covered by medicare Part A:

In-patient care in hospitals (for example critical access facilities, long-term care facilities, and inpatient rehabilitation centers)
In-patient care in a skilled nursing center (not pertaining to long-term care or custodial)
Home health care services
Hospice services

Medicare Part B (Medical Coverage):

Medicare Part B insurance offers doctor’s service that are of medical necessity, outpatient care, as well as numerous other services that Part A coverage alone fails to cover. Services Part B caters to may include some home health care-related services as well as physical or occupational therapies.</p> <p>Some preventative care services are also covered by Part B. Keep in mind that though many products and services are covered by both Parts A and B that it still does not equate to a complete health insurance coverage plan. There are still many coverages that Parts A and B simply do not cover, within the industry this lack of coverage in certain areas is called ‘gaps’ in the coverage.</p> <p>It is important to remember that if you don’t sign up for Medicare Part B during your initial enrollment period, there is a high chance that you will have to pay a penalty for late enrollment. Premium levels for Medicare Part B are set yearly by the Center for Medicare & Medicaid Services (otherwise known as the CMS). These premiums are based on an individual’s annual income. Say you only elect Original Medicare, should that be the case you are obligated to pay an annual deductible, after this is done Medicare will begin to pay for your Medicare Part B services.</p> <p>Enrollment in Medicare Part B may be automatic in the event that you are already receiving Social Security or RRB benefits. Part B benefits, just like Part A benefits are eligible to individuals the first day of the month that the individual turns 65 years old. Medicare Part B also extends its eligibility to those that are disabled, in certain qualifying circumstances, or if the individual has end-stage renal disease (ESRD).

Services covered by Medicare Part B:

An initial “Welcome to Medicare” physical exam followed by yearly “Wellness Exams”
Home Health Care Services: Medicare approved services, medical supplies, as well as medically necessary skilled care-related services.
Medical equipment such as mobility apparatuses (i.e. wheelchairs and walkers)
Office visits to a primary care physician or a specialist
Varying preventative services (i.e. mammograms, flu shots, things of that nature)
Laboratory costs including x-rays, and bloodwork
Mental health care treatment
Ambulance services
Outpatient physical therapy

Medicare Part C (Medicare Advantage):

Medicare Part C is offered by a third-party organization that contracts with Medicare to provide individuals with all their Part A and Part B benefits.</p> <p>Inclusive to Medicare Advantage Plans are Preferred Provider Organizations (PPO’s), Private Fee-for-Service Plans, Health Maintenance Organizations, Special Needs Plans, as well as Plans for Medicare and medical savings accounts.</p> <p>Being that you enroll in a Medicare Advantage Plan, most Medicare services are covered by the advantage plan itself and not paid for under Original Medicare.</p> <p>In most cases prescription drug coverage is offered by most Medicare Advantage Plans, however there is rare occurrence that this is not always the case.<br />

Medicare Part D (Prescription Drug Coverage):

Medicare Part D plans are stand-alone plans that add coverage for prescription drugs to your Original Medicare benefits. Part D plans assist in covering costs that are associated with prescription drugs, vaccinations, and various medical supplies that are not covered by Medicare Parts A and B.</p> <p>Medicare Prescription Drug Coverage plans came about to offer a solution to lower individuals’ prescription drug costs as well as to protect them against future costs that may arise that without this coverage the individual may be liable to pay in full. The Part D plan allows you affordability for drugs that are a medical necessity. Though there are certain factors in which this may not be the case (such as VA benefits, for example), you should enroll in Medicare Part D coverage to avoid penalties as soon as you come of eligible age.</p> <p>Certain Medicare Part D plans have a gap in coverage, this gap in coverage is that once a certain amount of money has been used for covered drugs, individuals will have to pay any further prescription drug costs out-of-pocket up to a set limit.</p> <p>The out-of-pocket limit is also comprised of the amount the individual has paid in the coverage gap, any copayments or coinsurance, as well as the individuals yearly deductible.

What do drug plans cover?

Medicare Part D plans are stand-alone plans that add coverage for prescription drugs to your Original Medicare benefits. Part D plans assist in covering costs that are associated with prescription drugs, vaccinations, and various medical supplies that are not covered by Medicare Parts A and B.</p> <p>Medicare Prescription Drug Coverage plans came about to offer a solution to lower individuals’ prescription drug costs as well as to protect them against future costs that may arise that without this coverage the individual may be liable to pay in full. The Part D plan allows you affordability for drugs that are a medical necessity. Though there are certain factors in which this may not be the case (such as VA benefits, for example), you should enroll in Medicare Part D coverage to avoid penalties as soon as you come of eligible age.</p> <p>Certain Medicare Part D plans have a gap in coverage, this gap in coverage is that once a certain amount of money has been used for covered drugs, individuals will have to pay any further prescription drug costs out-of-pocket up to a set limit.</p> <p>The out-of-pocket limit is also comprised of the amount the individual has paid in the coverage gap, any copayments or coinsurance, as well as the individuals yearly deductible.

How do I fill a prescription at the pharmacy?

Medicare Part D plans are stand-alone plans that add coverage for prescription drugs to your Original Medicare benefits. Part D plans assist in covering costs that are associated with prescription drugs, vaccinations, and various medical supplies that are not covered by Medicare Parts A and B.</p> <p>Medicare Prescription Drug Coverage plans came about to offer a solution to lower individuals’ prescription drug costs as well as to protect them against future costs that may arise that without this coverage the individual may be liable to pay in full. The Part D plan allows you affordability for drugs that are a medical necessity. Though there are certain factors in which this may not be the case (such as VA benefits, for example), you should enroll in Medicare Part D coverage to avoid penalties as soon as you come of eligible age.</p> <p>Certain Medicare Part D plans have a gap in coverage, this gap in coverage is that once a certain amount of money has been used for covered drugs, individuals will have to pay any further prescription drug costs out-of-pocket up to a set limit.</p> <p>The out-of-pocket limit is also comprised of the amount the individual has paid in the coverage gap, any copayments or coinsurance, as well as the individuals yearly deductible.

I don't have my new plan card yet, how do I get my prescription filled without it?

Medicare Part D plans are stand-alone plans that add coverage for prescription drugs to your Original Medicare benefits. Part D plans assist in covering costs that are associated with prescription drugs, vaccinations, and various medical supplies that are not covered by Medicare Parts A and B.</p> <p>Medicare Prescription Drug Coverage plans came about to offer a solution to lower individuals’ prescription drug costs as well as to protect them against future costs that may arise that without this coverage the individual may be liable to pay in full. The Part D plan allows you affordability for drugs that are a medical necessity. Though there are certain factors in which this may not be the case (such as VA benefits, for example), you should enroll in Medicare Part D coverage to avoid penalties as soon as you come of eligible age.</p> <p>Certain Medicare Part D plans have a gap in coverage, this gap in coverage is that once a certain amount of money has been used for covered drugs, individuals will have to pay any further prescription drug costs out-of-pocket up to a set limit.</p> <p>The out-of-pocket limit is also comprised of the amount the individual has paid in the coverage gap, any copayments or coinsurance, as well as the individuals yearly deductible.