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Introduction to Medicare

| October 19, 2017
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Just about everyone has heard of Medicare (although sometimes people confuse Medicare with Medicaid!). This is a first in a series of blogs that will explore the issues surrounding Medicare. The official website for Medicare information is https://www.medicare.gov.

Make Medicare Enrollment a Priority when Eligible:

The first time you can enroll in Medicare is called “The Initial Enrollment Period”.  This 7 month initial enrollment period

  • Begins 3 months before the month you turn 65
  • Includes the month you turn 65
  • Ends 3 months after the month you turn 65

NOTE:  If you DON’T enroll when you are first eligible, you may have to pay a late enrollment penalty.  Your monthly premium for Part B may go up 10% for EACH year you could have had Part B.  This penalty will stay in place as long as you have Part B!!

To begin with, let’s start with the most familiar parts, which would be parts A, B and D.

Medicare Part A (Hospital Insurance), where the premium is free, covers hospital services, including semi-private rooms, meals, general nursing, drugs as part of your inpatient treatment, and other hospital services and supplies. “

It also covers some care in other situations.  These tend to be mostly related to treatment and care following a hospital stay. Examples are:

  • Treatment in a skilled nursing facility.
  • Some nursing home care(as long as custodial care isn't the only care you need)
  • Hospice care, both at home and in a facility.
  • Home health services such as intermittent skilled nursing care, physical therapy, speech-language pathology services and continued occupational services.

Medicare Part B (medical insurance – doctors & surgeons). This can include outpatient care (doctor visits), preventive services (physicals, flu shots etc..), ambulance services, and durable medical equipment. It also covers part-time or intermittent home health and rehabilitative services, such as physical therapy, if they are ordered by a doctor to treat your condition.

So, what DOESN’T parts A and B cover?

Medicare parts A and B do NOT cover the following:

  • long term nursing home care
  • most dental care or dentures
  • normal eyecare, foot care, hearing aids, acupuncture, or any cosmetic surgery
  • drugs unless administered during a hospital stay (that is where part D comes in)

Medicare Part D is for prescription drug coverage.  For Medicare part D coverage, you would enroll in one of the private insurance plans that Medicare has approved to provide it. There are many plan choices. The cost and coverage depends on several factors. Each Medicare drug plan has its own list of covered drugs (called a formulary). Many Medicare drug plans place drugs into different "tiers" on their formularies. Drugs in each tier have a different cost. The cost of the plan depends on what drugs are in each tier. The key for most people is balancing the higher premiums with getting the more expensive drugs you take into lower tiers. Drug coverage can also be included with Medicare Part C, but that’s another topic for discussion.

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