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Simple Explanation of Medicare

Simple Explanation of Medicare Posted on September 1, 2014Leave a comment

Medicare Part A

Part A covers you for services of medical "entities." This coverage contains benefits for hospitals, skilled nursing care facilities, home health care and hospice care treatment. For in-patient hospital treatment, you are covered for up to 90 days for each "spell of illness." Medicare patients must satisfy a deductible before benefits begin. After you are out of hospital for 60 days after in-patient treatment, you may be covered for another "spell of illness" for up to 90 days. Additional time periods apply to skilled nursing, home health and hospice care based on the differences in their rates and treatment types.

Medicare Part B

Part B, an optional feature, covers you for non-institution services, like doctor’s visits, inoculations, medical tests and other outpatient services. For those receiving monthly Social Security payments, the government will deduct Part B premiums for you — around $100 per month. Like Part A, before Medicare pays anything, you must meet annual deductible amounts. Always learn if your physician accepts Medicare payments, as you will be responsible for any charges that are in excess of these insurance reimbursements.

Part C

Called Medicare Advantage (MA), this coverage is offered by private insurance companies and effectively replaces Parts A and B. You must be enrolled in both standard Medicare coverage (Parts A and B) to be eligible for this protection. Part C plans can be structured as HMOs (health maintenance organizations), PPPs (preferred provider plans) or private fee for service plans, which means you can use any physician willing to accept Medicare payment for services. MA plans are popular because you can get services unavailable from Medicare, like dental and vision coverage.

Part D

Medicare Part D offers prescription drug coverage. Available since 2006, Part D coverage can be a wonderful benefit for seniors who must continue a regimen of expensive medications on a regular basis. Like Parts A and B, there is a penalty if one enrolls in Part D at a time other than the annual enrollment period or when you turn 65. Penalties for late enrollment are similar, usually around 10 percent of the monthly premium combined with the number of months elapsed before you enrolled. Annual enrollment periods run from November 15 to December 31 every year.

Medigap Coverage

An alternative to Part C Medical Advantage plans, Medigap coverage attempts to fill the "gaps" in Medicare Parts A and B. When you examine the coverage offered by Parts A and B, you will learn that there are gaps that will cost you out-of-pocket money, even after annual deductibles are met. Purchasing Part C MA plans eliminates and replaces Parts A and B, while Medigap assists with coverage when you still have Parts A and B. Medigap plans are offered by private insurance companies.


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