As people get too old to work, they think about how they will meet their healthcare needs. Along with the aging process, health needs change and may even increase. Here in the United States, you may be eligible for Medicare, a federal health insurance program for individuals 65 and older, people with End-Stage Renal Disease, and some younger individuals with disabilities. There are many different parts to Medicare. Original Medicare includes Medicare Part A and Part B. Medicare Advantage plans include Medicare Part C.
Funding for your Medicare comes from different sources, including payroll taxes, income taxes on Social Security benefits, the Hospital Insurance Trust Fund, and the Supplementary Medical Insurance Trust Fund.
Medicare Part A
Under Original Medicare is Medicare Part A, also known as hospital insurance. Medicare Part A covers inpatient care at a hospital, home health care, hospice care, care in a skilled nursing facility as well as nursing home care. Under Medicare Part A, patients are responsible for their deductibles, copayments, and non-covered services.
Medicare Part B
Medicare Part B covers outpatient medical services and preventative care. If you were wondering about your coverage for flu shots, mammograms, colonoscopies, lab tests, home health care, or even chiropractic care, then they will be covered by your Medicare Part B. It also covers your ambulance services, whether you need to be transported by ground, helicopter, or airplane.
If you are interested in being involved in clinical research studies, then your Medicare Part B may be able to cover your treatments. Qualifying research tests can provide you with the care you need, and the answers scientists are looking for.
Medicare Part B also covers your durable medical equipment (DME). First, you need to pay your deductible, and 20% of the Medicare approved amount. Medicare may require you to rent the equipment, buy the equipment, or they may give you the choice to rent or buy the equipment. The equipment that is covered includes:
- Blood sugar meters and test strips
- Continuous passive motion devices
- Continuous Positive Airway Pressure (CPAP) devices
- Commode chairs
- Crutches, canes, and walkers
- Home infusion services
- Infusion pumps and supplies
- Traction equipment
- Wheelchairs and scooters
In 2021, the standard Part B premium costs $148.50 per month. Although most people pay this premium amount, you could pay more than a standard premium amount called the Income Related Monthly Adjustment Amount (IRMAA), which is an extra charge added to your premium.
Medicare Part C or Medicare Advantage Plans
Despite how much it looks like Original Medicare may cover, there is a lot that these plans do not offer. Medicare Part C or Medicare Advantage Plans fill in those “gaps” in Original Medicare coverage. These programs were created by Congress under the Balanced Budget Act of 1997 so Medicare beneficiaries could enjoy lower premium options than what Medigap was offering and still receive excellent care. With a Medicare Advantage Plan, you receive your benefits from a private insurance company rather than Original Medicare, but in order to keep your plan, you must remain enrolled in both Medicare Part A and B. These plans are funded by Medicare paying a fee to your private insurer on your behalf for taking on your medical risk when they chose to insure you.
Medicare Part D
Medicare drug coverage falls under your Medicare Part D plan. Your plan may include brand-name prescription drugs and/or generic prescription drug coverage. The list of covered drugs in your plan is called a “formulary.”
How do I enroll in Original Medicare or Medicare Advantage Plans?
You will automatically be enrolled in Original Medicare if you receive benefits from Social Security or the Railroad Retirement Board. These benefits will start the first day of the month that you turn 65. If your birthday happens to fall on the first day of the month, then your Medicare Part A and Medicare Part B will be effective the first day of the month before your birthday. Between 1 to 2 months before your 65th birthday, your card will be mailed to you.
If you were not receiving Social Security benefits, then you can apply online, by phone or by mail. Before you apply, however, it is highly recommended to learn about medicare insurance in Arizona to go over your different options, especially if you are choosing to purchase a Medicare Advantage Plan.