Help To Decipher The Medicare Maze

Question: Medicare can be so hard to understand, How are we supposed to know what to do?

Answer: Medicare is such a big concern for many Americas (over 65 Million are enrolled in Medicare). When you factor in those individuals that help someone with Medicare that is an even bigger number of American’s that are thinking about Medicare.

I first want to give some basics about Medicare. Original Medicare was established in 1965. Original Medicare is considered Medicare Part A and Medicare Part B. Medicare part A is the Hospitalization component and that is paid for with the taxes taken out of your paycheck. When you enroll into Medicare Part A for most American’s there is no premium. Medicare Part A covers Hospitalization, Nursing Home Stays and Home Care after a hospital stay, and hospice in any situation.

Medicare Part B is the Medical component, and for most American’s the monthly premium is $174.70. For those with higher incomes there is an additional premium called an IRMAA (Income Related Month Adjustment Amount). Medicare Part B we refer to as ‘Outpatient’ coverage. It all those services done outside a hospital stay, like ambulance, Emergency Room, Physicians, labs, testing, treatments, durable medical equipment, and much more.

What we know today as Medicare Advantage plans, began in 1970’s. At that time, it was known as Medicare Part C and today you sometimes see it called that. During the mid-1990’s it became much more common and the plans began to increase. The name changed over the years to Medicare Choice and now we call them Medicare Advantage Plans. Occasionally you seem them called Medicare Health Plans. Medicare Advantage Plans are offered by private companies and replace your Original Medicare Benefits. These plans use the term ‘bundle’ to explain their benefits. They provide hospitalization, outpatient and Part D. There are also Medicare Advantage plans without Part D.

The Prescription Drug benefit, Part D began in 2006. This Part D benefit is also provided by private insurance companies, but is a requirement once you are eligible for Original Medicare. The Part D benefit includes those medications you purchase at the pharmacy or could receive through a mail order pharmacy.

There that seems pretty easy right? Not really. Each part of Medicare has different rules and regulations relating to how you enroll, when you are required to enroll and the penalties for not enrolling. I often say it is similar to the game of chess. Each of the pieces on the board can do different things during the game and each piece impacts the other pieces. Medicare is the same way. Medicare Part A, Part B, Part D and Medicare Advantage all have different rules and how you combine those rules and offerings to meet your need can be pretty complicated.

You do have some tools to learn about Medicare. The first I would offer is the Medicare and You Handbook you receive each year. This has been published each year and includes the necessary information for you to understand the rules. This book has improved significantly over the years. The information in it covers the rules and regulations of Medicare and helps to direct you on how to choose your specific plans. The book that was mailed to you was specifically designed for your state and in the back lists all the plans available in your STATE. It is important to understand that your available plans are based on your COUNTY of residence. So NOT all those plans in the back are available to you. You must filter them a bit.

You can call Medicare at 1-800-medicare (800-633-4227) and the staff will help you to work through your questions and concerns.

You also have the www.medicare.gov website to learn about Medicare. The website offers lots of information and tutorials to help you understand your choices. Websites can be interactive so you can move through the information based on your specific questions and concerns. The website also allows for you to created a login once you are Medicare eligible to track your own specific situation and information. I highly recommend establishing this login and using the medicare.gov website to its fullest potential.

Another resource is the Medicare Rights Center (800-333-4114), or www.medicarerights.org. This organization works to advocate for those enrolled in Medicare.

I appreciate your curiosity and I hope this information helped you to understand your Medicare benefits. Keep digging and I know you will learn!

Janell Sluga is a Geriatric Care Manager helping seniors in our community access services and insurance. To reach her, please email editorial@post-journal.com.


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