Over 45 million Americans are covered by Medicare, making the United States Medicare system one of the largest single payer medical insurance system in the world. If you are new to Medicare, you probably have questions about Medicare coverage. Read on for an overview of the Medicare system and where to go for Medicare tips and advice.
Parts is parts: Medicare coverage by the letters.
Government health insurance for seniors is an alphabet soup, so it may help to start with which part of Medicare covers what.
Medicare coverage under Parts A and B are often referred to as “original Medicare” – mainly because that is exactly what it is. Generally speaking, Medicare Part A provides coverage for trips to the hospital and hospital stays of up to about three weeks.
Part B Medicare coverage is the real medical insurance. Medicare Part B handles other medical visits, outpatient procedures and medical devices such as manual wheelchairs and walking canes. It also covers medical expenses incurred by treatment by medical specialists who may work in hospitals, but which do not fall under the hospitalization coverage of Medicare Part A, such as oncologists.
Plan C is a hybrid of private insurance and public insurance under Medicare. Medicare Plan C is also referred to as Medicare Advantage, and it consists of Medicare Plan A and Medicare Plan B plus extras from your private insurer, for which you pay a premium. Do not let that put you off, however, as Medicare coverage under Plan C can be a good deal for many people.
Medicare Part D is the newest addition to the Medicare family, and it provides Medicare coverage for prescriptions.
But what about the Healthcare Reform Bill that just cleared the Senate?
Think of the health care compromise bill that just cleared the Senate as Medicare Part F. The Senate bill would provide Medicare coverage for US citizens 55 to 65 years old. In other words, the Senate traded a public option for everyone for an expanded Medicare system that would cover those seniors old enough for AARP but too young for Medicare. The House healthcare reform bill is different, and neither healthcare reform bill would dramatically affect government insurance for those citizens who already qualify for Medicare coverage.
The nuts and bolts provisions of the different healthcare reform bills floating around out there are all hypothetical at this point. However, none of the bills currently being debated will take away Medicare coverage for those citizens over the age of 65, so I mention it only to put your mind at ease.
Get with the program! Enrolling for Medicare coverage.
If you are about to turn 65 and you are already collecting Social Security benefits on your own behalf, or if you receive dependents’ benefits or survivors’ benefits from Social Security, or if you are collecting federal pension retirement benefits, or if you receive Social Security disability benefits or if you have been eligible to receive Social Security disability benefits for 2 years even though you have not been collecting them, you will be automatically enrolled in free Part A Medicare coverage.
You should receive notice, documents and forms to fill out in the mail a few months before your 65th birthday. If you do NOT receive information about Medicare coverage from the government two months before you turn 65, contact the Social Security Administration by calling 1-800-772-1213.
If you qualify for Social Security or another federal retirement or pension benefit, you must enroll enroll for free Medicare coverage under Medicare Part A at the nearest Social Security office. You should enroll as early as three (3) months before you turn 65 to make sure that all the paperwork is processed in time. If the paperwork is not processed in time, it is OK and you will still have Part A Medicare coverage as long as you apply within 6 months of your 65th birthday, but your Medicare coverage will generate a lot less paperwork and stress if you do it early.
If you do not qualify for Social Security coverage, you can still enroll in Medicare Part A and receive Medicare coverage, but you will have to pay a small premium for your government insurance. The procedure is the same as above.
You must also enroll for Medicare coverage under Part B unless you are already receiving Social Security benefits or a federal civil service pension. If you are, you will receive a packet of documents pertaining to the initial enrollment period for Medicare coverage under Part B in much the same way as discussed above. You can decline Medicare coverage under Part B even if you have been automatically enrolled.
You must also enroll for Medicare coverage under Part C (Medicare Advantage Managed Care plans) and Part D (Medicare Prescription coverage).
Medicare coverage under Parts B, C and D require the payment of a premium. Government insurance premiums under Medicare Part B is usually deducted from your Social Security or federal pension check.
It’s not fashionable to be late: Initial enrollment periods and Medicare coverage.
It is best to enroll for coverage under Part B, Part C and Part D before you turn 65 or at the very latest, within three months after the month that you do turn 65. (ie. If your birthday is in January, your initial enrollment period lasts until April 30th.) For one thing, unlike Part A, Medicare coverage under the other Parts does not date back to your birthday.
More importantly, if you miss your initial enrollment period, you have to wait for the open enrollment period to enroll, and once you do enroll, Medicare coverage will not begin immediately.
It gets worse. The longer you delay enrollment in Medicare coverage, the more you have to pay. In fact, you may pay as much as ten percent more for Medicare coverage- for each year you delay. If you are the type who hates to fill out paperwork or make decisions, bite the bullet and stop procrastinating. Your wallet will thank you, and your inconvenience now will be more than covered by the peace of mind that comes from knowing you have Medicare coverage for your medical expenses down the road.
For more information about enrolling in Medicare plans, monthly premiums and other questions regarding Medicare coverage, see the links in the Sources and Resources section at the end of this article.
Online resources for Medicare coverage questions.
Caring.com is an impressively organized and helpful website dedicated to helping adults care for their parents. Caring.com’s outstanding Medicare Information Finder makes it easy to find out if a particular procedure, medication or medical advice is covered by Medicare and, if so, whether it is covered by Medicare Part A, Part B, Part C, Part D or a combination thereof.
Caring.com’s Medicare Information Finder also has coverage information about other medical services. For example, Adult Daycare is not covered by Medicare Part B, but Mental Health Services are covered even if they happened to be offered by an Adult Daycare Facility, so you might qualify for Medicare coverage after all.
Please note: I am not affiliated with Caring.com in any way. Even so, I suggest you check out the Caring.com website for well formatted and easy to understand information about Medicare coverage.
Sources and Resources
Medicare.gov: the official US Government Medicare site
Kaiser Family Foundation