Understanding and navigating the coverage options for Medicare before you turn 65 years old can help you face the challenges of Medicare enrollment information when your birthday rolls around. Keep in mind that benefits and premiums are subject to change yearly and differ from state to state. We’ve put together a quick look at the types of plans available for Medicare recipients.
Medicare Part A
Part A is also known as Original Medicare. Coverage includes hospitalization, skilled nursing facility stay (short-term), hospice care, lab tests, surgery, and home care (short-term).
Medicare Part B
Part B is the medical insurance that includes doctor visits, outpatient care, durable medical equipment, preventive services such as vaccinations, screenings, and yearly wellness visits. A monthly premium is set by the Federal Government which is deducted from your Social Security benefit. High-income earners pay more for co-pays, deductibles, and premiums. This premium is adjusted yearly.
Medicare Part C
Medicare Part C is Medicare Advantage Plans which are offered by private companies who are contracted with Medicare to provide Part A and Part B benefits. They offer extra coverage such as vision, hearing, dental, and/or wellness programs. Prescription drug coverage (Part D) might be offered as a benefit as well. An additional monthly premium for an Advantage Plan would be paid directly to the Advantage Plan, not the government. Refer to the Medicare Advantage terms you might see when investigating below to help with your research.
Medicare Part D
You would need to sign up for Prescription Drug Coverage, Part D through an Advantage Plan or Part A. If you do not choose Part D with your traditional Part A and want to add it at a later date, you will incur a penalty which will last as long as you have Part D.
Medigap or Medicare Supplement Insurance
There are plans that help pay some healthcare costs that Medicare Part A and Part B do not cover, such as co-pays, co-insurance, and deductibles. These plans are available through private companies that you would monthly directly. Medigaps usually do not cover vision, dental, hearing aids, Long Term Care, or private-duty nursing.
Shopping Around For What is Best For You
Companies may charge different premiums for the same service, so shopping around for these plans is advised during the open enrollment period. It is important to know what is covered by Parts A & B in order to make the best decision for you. It is not always necessary to have a supplemental if you are still receiving coverage from employment, but you must research all options.
Here’s a list of what is NOT covered by Medicare Part A & B:
- Prescription Drugs (Covered by Part D & Advantage Plans or some Retiree plans)
- Dental Care (Some Advantage Plans cover basic cleanings and X-rays)
- Eye Exams, glasses, & contact lenses. If you have Diabetes or glasses after cataract surgery, you may be covered. (Some Advantage Plans cover vision).
- Hearing Exams and hearing aids (Some Advantage Plans cover them or provide lower-cost hearing aids).
- Routine foot care is not covered, but Part B will cover foot examinations and treatments due to diabetes plus injuries such as heel spurs and hammertoes.
- Elective cosmetic surgery is not covered, only plastic surgery to correct accident injuries.
- Medical Costs outside the United States. (Some Advantage Plans cover emergency care abroad, and certain Medigap plans cover up to 80% of services outside the U.S.).
- Long Term Care services including Custodial care, Assisted Living facilities, Home Health Aides (HHA’s), and institutional nursing home costs are not covered. Short-term stays will be covered after surgery such as hip replacements.
Staying Informed
Medicare information is challenging and confusing to most people. Educating yourself through good research will be helpful in navigating the many terms and benefits of each part of Medicare. A good place to start would be the Medicare website or 1-800-MEDICARE (1-800-633-4227).
Important Medicare Acronyms
Medicare acronyms can be confusing also. Below is a list to help in your research.
IEP- Initial Enrollment Period (Centers around your 65th Birthday)
AEP- Annual Enrollment Period (October 15 to December 7th)
SEP- Special Enrollment Period (you must meet special requirements to enroll at this time)
MA OEP- Medicare Advantage Enrollment Period (January 1 to March 31, can also
make changes to your plan at this time)
MA – Medicare Advantage Plan
MAPD – Medicare Advantage Plan with Prescription Drug coverage.
Medicare Part C Acronyms
HMO – Health Maintenance Organization. With an HMO, you usually have to use doctors and hospitals within the plan’s network to make sure the plan covers your care.
POS – Point of Service. This is a type of HMO plan that lets members go outside the network for some covered services. You might have to pay a higher copayment or coinsurance for those services.
PPO – Preferred Provider Organization. With this type of plan, you can use doctors and hospitals inside or outside of the network. If you go outside the network, you may pay a larger share of the cost of your care.
SNP – Special Needs Plans are a type of Medicare Advantage Plan that serves people with special health care needs, such as ESRD (End Stage Renal Disease) or diabetes.
Other Plans Acronyms
PFFS – Private Fee-For-Service. Allows you to visit any Medicare-eligible doctor, hospital, or healthcare provider who accepts the plan’s payment terms and conditions.
MSA – Medical Savings Account. Combines a special medical savings account with a high-deductible Medicare Advantage plan.
PDP – Prescription Drug Plan. Also called Medicare Part D, this is a standalone plan that helps you pay for prescription drugs.
Safe Harbor Healthcare Services does not provide medical, healthcare, or financial advice via articles. This material has been prepared for informational purposes only. It is not intended to provide, and should not be relied on for medical advice.
Safe Harbor Healthcare Services has provided excellent home care on Staten Island since 1967. Our services help older individuals and the disabled live safely and independently; while giving their families the peace of mind they need. For more information contact us by clicking here, or call (718)-979-6900.
