Medicare is a federally funded health insurance program designed primarily for individuals aged 65 and older. It also covers certain younger individuals with disabilities or those with end-stage renal disease. Medicare consists of different parts, each serving specific purposes:

Medicare Part A: Part A covers hospital insurance, including inpatient care, skilled nursing facility care, and some home healthcare services.

Medicare Part B: Part B covers medical insurance, including doctor visits, outpatient services, preventive care, and medical equipment.

Medicare Parts C & D: Part C refers to Medicare Advantage plans, which are offered by private insurance companies approved by Medicare. These plans provide an alternative way to receive Medicare benefits. Part D covers prescription drug plans to help offset the costs of prescription medications.

Medicare offers a wide range of coverage to ensure seniors have access to essential healthcare services. Here’s a breakdown of what is covered by each part:

Part A: Inpatient hospital care, skilled nursing facility care, hospice care, and limited home healthcare.

Part B: Doctor visits, outpatient services, preventive care, durable medical equipment, and some mental health services.

Part C: Medicare Advantage plans combine the benefits of Part A, Part B, and sometimes Part D, offering additional services such as vision, dental, and hearing coverage.

Part D: Prescription drug coverage, which helps reduce the cost of medications prescribed by doctors.

While Medicare provides comprehensive coverage, it’s important to note what is NOT covered:

Long-term care, including custodial care in nursing homes.
Routine dental care, dentures, and most dental procedures.
Routine vision care, eyeglasses, and exams for glasses.
Hearing aids and exams for fitting them.
Acupuncture and alternative therapies.
Cosmetic surgery.

Understanding the differences between Medicare Advantage (Part C) and Medicare Supplement (MediGap) + Part D coverage is essential when choosing the right plan for your needs.

Medicare Advantage plans, such as HMOs or PPOs, are offered by private insurers approved by Medicare. They provide all the benefits of Medicare Parts A and B, with additional coverage options. These plans often include prescription drug coverage and may offer extra benefits like dental, vision, and fitness programs.

On the other hand, Medicare Supplement plans, also known as MediGap plans, are offered by private insurance companies to fill the gaps in Original Medicare coverage. These plans help pay for certain out-of-pocket costs, such as deductibles, copayments, and coinsurance. They do not include prescription drug coverage, so you would need to enroll in a separate Part D plan.

Enrolling in Medicare requires understanding eligibility and the enrollment process. Most individuals are automatically enrolled in Medicare Part A and Part B when they turn 65 and are already receiving Social Security benefits. However, if you are not automatically enrolled, you can apply during specific enrollment periods.

It’s important to note that enrolling in Social Security or receiving disability payments will impact your Medicare enrollment process. You may be automatically enrolled or need to apply manually, depending on your circumstances.

Medicare offers programs to assist individuals who may have difficulty affording Part B or Part D premiums:

Medicare Savings Programs: Administered by Medicaid, these programs help eligible individuals pay for Medicare premiums, deductibles, copayments, and coinsurance.

Extra Help Program: Also known as the Low-Income Subsidy, this program assists individuals with limited income and resources in paying for prescription drug costs under Medicare Part D.

IRMAA (Income-Related Monthly Adjustment Amount): IRMAA is an additional premium amount some high-income individuals may pay for Medicare Part B and Part D, based on their income tax returns.

EPIC (Elderly Pharmaceutical Insurance Coverage): Exclusive to New York State residents, EPIC is a pharmacy assistance program that helps lower prescription drug costs for seniors.

Medicare’s Open Enrollment Period is a crucial time for all Americans enrolled in Medicare. It typically runs from October 15th to December 7th each year. During this period, individuals can make changes to their Medicare coverage, including switching between Medicare Advantage and Original Medicare, changing Part D prescription drug plans, or selecting new Medicare Advantage plans.

It’s important to review your current coverage and consider any changes that may better suit your needs. Take this opportunity to ensure your healthcare coverage aligns with your evolving requirements.