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To most people, Medicare can feel like a giant mystery with no easy answer. Knowing how Medicare is organized and what you specifically may need, can feel daunting, but when you break it down piece-by-piece, the program becomes much clearer.
To start, Medicare is a federal health program that is meant for those 65 and older, as well as some younger individuals with certain disabilities. It can be easily confused with Medicaid, which is a program that targets low-income individuals, instead of being age-based like Medicare.
Medicare offers basic coverage through Parts A and B, which together are known as “Original Medicare.” These parts are run through the Social Security Administration and offer more basic healthcare coverage. Original Medicare is typically offered at no additional cost if you qualify because of the money you paid into the system through taxes over your working years.
Many people may also want to enroll in optional Parts C and D, which offer additional coverages at an extra cost. These parts are offered through private companies, so they are not set up standard across the board like Parts A and B.
To better understand what each Medicare part covers, keep reading for a helpful breakdown that is sure to help your decision making process.
Part A: Hospital Coverage
Part A focuses on hospital coverage. This can include things like inpatient hospital stays, home health care, and skilled nursing facility care. The majority of people don’t pay for Part A because they have paid Medicare taxes over time while working. Those taxes end up covering the cost automatically. If you don’t qualify for Part A based on what you have paid into the system, then you can purchase it at a monthly premium. It is crucial to sign up for Part A to cover any unexpected hospital and medical assistance needs, which typically become more and more common for people as they age.
Part B: Outpatient Coverage
If you are wondering what Medicare Part B covers, you can think of things like visiting the doctor, outpatient services, X-rays, lab tests, and preventative screenings. If you no longer are getting these services covered through a current job or your spouse’s plan, then you should highly consider enrolling in Part B. If you do already have medical coverage through another source, then you can delay your Part B enrollment without penalty. Another thing to know is that if you plan to sign up for a Medicare Advantage plan, you must also be enrolled in medical coverage through Medicare Part B.
Part C: Advantage Plans
If you have heard of Medicare Advantage plans, these are the same thing as Part C. Part C plans are offered through private health insurance companies. If you enroll in an Advantage Plan, you technically still have Medicare, but the coverage is through the private company the Advantage Plan is through. Many people choose to pay the extra money to enroll in Part C because you can get more coverage of services and extra perks and benefits. Many find that the cost is worth the extra peace of mind that more healthcare services will be covered. It is really important to review the different Part C offerings from each company before deciding what is best for you.
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Part D: Prescription Drugs
Part D focuses on prescription drugs. Similar to Part C, Part D is offered only through private insurance companies. A lot of times, Part D is included in a Part C plan, but you can also opt to purchase a Part D separately. You may wonder why Part D is potentially a good choice for you when Part B does cover some medications. The difference between the two parts is that Part D offers a much wider range of coverage for outpatient prescription drugs and vaccines. Just like Part C, it is important to compare different Part D plans to decide which one to go with.
Photo by cottonbro studio at PexelsDecoding all of the different parts of Medicare can be overwhelming. Luckily, there are many other resources online that can help as you figure out the next steps to take in your healthcare journey. A good place to start is to outline your healthcare needs currently, and then outline what additional needs you expect to have in the foreseeable future. You can then take those needs and compare what is covered under Medicare part- by-part. If you see gaps after looking through what Part A and Part B cover, then it may be time to look at Part C and D under Medicare Advantage plans. Remember to take things slow and ask as many questions as needed when making choices regarding your healthcare coverages.
Sandyside Senior Living
This information was provided by Sandyside Senior Living in White Lake, Michigan. Sandyside specializes in advanced care for seniors with dementia, Parkinson’s, and all age-related illness.
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