Making Sense of Medicare

Did you know that Medicare is one of the country’s largest group health insurance plans? And while millions of Americans are eligible for this federal program, few people understand its ins and outs. Let’s take a closer look at this tricky topic, along with some things to keep in mind when evaluating your Medicare options.

What is Medicare?

Simply put, Medicare is the federal government’s health insurance plan for senior citizens. Some younger people with disabilities as well as people with end-stage kidney failure are also eligible. Medicare is divided by types of service into four different parts, including:

Medicare Part A, which covers hospital care including inpatient stays, skilled nursing facility care, some home health care and hospice care.

Medicare Part B, which covers medical care, including specified doctors’ services, outpatient care, medical supplies, and preventative care.

Medicare Part C, a type of plan which provides all Part A and Part B benefits through private companies (Also called Medicare Advantage Plans, many also offer prescription drug coverage.)

Medicare Part D, which offers prescription drug coverage through private plans as an add-on feature to Original Medicare types (Parts A and B) If you’re not sure which type of coverage you have, refer to your Medicare card and all other current insurance cards. Additionally, you can check your Medicare health or drug plan enrollment or call 1-800-MEDICARE (1-800-633-4227).

Understanding Your Medicare Options

If you aren’t yet enrolled in Medicare, the U.S. government site for Medicare provides a handy Eligibility and Premium Calculator (visit https://www.medicare.gov/). People who are already receiving Social Security benefits may be automatically enrolled in Medicare, and will receive their Medicare cards by mail three months before turning 65.

If you are still working and not yet receiving Social Security Benefits, you may need to sign up in order to receive coverage. You can do this by applying online, visiting your local social security office, or calling Social Security at 1-800-772-1213. Wondering whether you should select Part B as well as Part A? This can help.

If you currently have healthcare coverage through a current or former employee, it’s important to understand how it works in order to make the most out of Medicare. Your benefits administrator, insurer, or plan provider can answer any questions you have about your current insurance plan.

One last thing to keep in mind about Medicare? You can still expect to pay premiums, copayments and deductibles, unless you quality for low-income assistance and/or have additional coverage. Additionally, Medicare doesn’t cover comprehensive health care costs. For example, services like vision and routine dental care are not included in the plan. If you’re not sure whether a particular test, item or service is covered, you can search for it by name. Your healthcare provider can offer additional information about why a particular type of care is necessary even if not covered.

Feeling overwhelmed by navigating the complexities of Medicare? You’re not alone. Medicare.gov is a thorough repository of information about Medicare -- from getting started to finding health and drug plans. Additionally, the State Health Insurance Assistance Program (SHIP) offers personalized health insurance counseling aimed at helping people make the most informed health insurance decisions. Visit them here: https://www.shiptacenter.org/.

Key Takeaways

• Understanding Medicare and your Medicare options can help you make the best decisions about your health insurance coverage.
• Medicare is not “one size fits all.” It is multifaceted and depends on everything from the type of care you need to whether you have other health insurance which works with Medicare.
• While navigating Medicare can be challenging, there are many resources available to help.