We can all agree that the Medicare “jungle” is a treacherous place to navigate.  There’s so many terms, so many changes, and far too much to ever remember.  

As with anything that seems overwhelming, the best way to understand it is to simply “eat the elephant one bite at a time”.  Small bites, of course!

To help with that, I’m going to break down each one of the parts of Medicare.  We’ll take a close look at Parts A, B, C, and D with hopes of developing a better understanding of what each one does…and doesn’t…entail.

First, What is Medicare?

  • Medicare is a federal health insurance program that pays for a variety of health care expenses. 
  • Medicare was created in 1965 to provide health coverage for Americans age 65 and older. 
  • The program was expanded in 1972 cover younger Americans who have permanent disabilities. 
  • It’s administered by the Centers for Medicare & Medicaid Services (CMS), a division of the U.S. Department of Health & Human Services (HHS). 
  • Medicare is an entitlement program, similar to Social Security.
  • There are 4 different “parts” of Medicare.  There’s Part A, Part B, Part C and Part D.  Each of these cover a different aspect of healthcare.  Each part is funded differently.  
  • It’s also good to remember that A, B, and D work together while Part C is a different creature.  You either have A, B and D….. or you have C!

Who is eligible for Medicare?

Generally speaking, you are eligible for Medicare if one of the following applies:

  • you are 65 years old, and have been a legal permanent US resident for at least five continuous years.
  • you are under 65 and have amyotrophic lateral sclerosis (ALS) – also known as Lou Gehrig’s Disease – or end-stage renal disease (ERSD); or
  • you aren’t yet 65, but have been entitled to Social Security Disability benefits for at least 24 months.

What is Medicare Part A?

Part A is usually referred to as “hospital insurance”.  It covers the following:

  • Inpatient hospital stays (of at least one night)
  • Skilled nursing facilities (see my post (link to skilled nursing blog in senior housing)__ for more details)
  • Home health care
  • Hospice care

How Much Does Part A Cost?

Part A is known as “premium-free Part A”.  In other words, you receive Part A for freeupon enrollment!  It is funded primarily by payroll taxes, which end up in the Hospital Insurance Trust Fund.

Simply put…if you have Medicare…you automatically have Part A.

In order to get Medicare Part A with no premium, you also need to have paid into the Medicare system. This means that you or your spouse must have worked for at least ten years prior to enrolling in Medicare. If not, you’re still eligible, but will have to pay a premium for Medicare Part A.

Medicare Part A typically doesn’t cover the full amount of your hospital bill, so you will probably be responsible for a share in the cost. You will also have to pay a deductible before Medicare benefits begin. 

After that, Medicare will then pay 100% of your costs for up to 60 days in a hospital or up to 20 days in a skilled nursing facility. After that, you pay a flat amount up to the maximum number of covered days. 

How do I sign up for Medicare Part A?

You can enroll in Medicare Part A and/or Medicare Part B in the following ways:

  1. Online at www.SocialSecurity.gov.
  2. By calling Social Security at 1-800-772-1213 (TTY users 1-800-325-0778), Monday through Friday, from 7AM to 7PM.
  3. In-person at your local Social Security office.

What is Medicare Part B?

Medicare Part B is simply coverage of medical services and supplies.  It covers the following:

  • Provider services: Medically necessary services you receive from a licensed health professional.
  • Annual “wellness” doctor visit every 12 months
  • Lab tests such as x-rays, bloodwork,
  • Equipment such as wheelchairs, oxygen tanks, walkers, diabetic testing supplies, hospital beds for the home
  • Orthotics and prosthetics
  • Renal dialysis
  • Mental health services
  • Ambulance services
  • Home health services if you are homebound and need skilled nursing or therapy care.
  • Diabetes Education
  • Select prescription drugs, including immunosuppressant drugs, some anti-cancer drugs, some anti-emetic drugs, some dialysis drugs, and drugs that are typically administered by a physician.

How Much Does Part B Cost?

Unlike Part A, you must pay a monthly premium for your Medicare Part B benefits. 

Part B funding comes from general revenues and the premiums paid by Medicare beneficiaries.

The majority of Americans will pay the standard monthly amount set by the government. In 2019, the base rate for Part B is $135.5/month for people new to Medicare. However, you may owe more if your income is above a certain level.

Medicare will deduct your Part B premiums out of your Social Security check if you are already enrolled in your SS income benefits. If not, they will bill you quarterly. 

If you enroll late into Part B, you may also have to pay a penalty for life. It’s important not to miss your enrollment window whenever you retire and lose access to your employer group health insurance.

How Do you Sign Up for Medicare Part B?

People who are already taking Social Security income benefits at age 65 do not need to enroll. The Social Security office will automatically enroll you. Your card will arrive in the mail 1 – 2 months before your 65th birthday.

Everyone else needs to apply for Medicare Part B themselves at age 65.  Applying for Medicare Part B can be done online, over the phone or in person at your local Social Security office. After you apply, it will take 2 – 3 weeks before your card will arrive, so you should plan to apply several weeks prior to when you will need the coverage.

It’s important to carry your Medicare card with you. Doctors, other health care providers, and facilities know it’s coming and will ask you for it.

These cards have a Medicare Number that’s unique to each person with Medicare, instead of their Social Security Number.

What does Medicare Part A & B NOT cover?

Some of the items and services that Medicare doesn’t cover include:

  • Long-term care (also called custodial care  ie: nursing home)
  • Most dental care
  • Eye exams related to prescribing glasses
  • Dentures
  • Cosmetic surgery  
  • Acupuncture  
  • Hearing aids and exams for fitting them
  • Routine foot care

To find out if your test, service or item is covered, please go to www.medicare.gov/coverage.  This site allows you to type in exactly what you’re looking for to see if it’s covered.

Again, this is a brief summary of Parts A & B.  I’m taking a few small bites of a very big sandwich. There’s always so much more to learn and understand.  If there’s still more you’d like to know, you can always visit the official U.S. Government site for Medicare, www.medicare.gov.  

The more you know the better you can navigate!

Info obtained from the following sources: www.medicareresources.org/basic-medicare-information/what-is-medicare/www.medicare.gov

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