March 6, 2013 § Leave a comment
Over 46 millions older or disabled Americans are covered by Medicare. Yet, there are still misconceptions about the program that provides health care coverage to this vast number of Americans. To those approaching Medicare eligibility age (65), it’s important to understand the programs. In our blog, we will cover several misconceptions cover the next few weeks.
#1 THERE IS ONE MEDICARE PROGRAM
Medicare has several different programs, designated as “Parts,” with different types of coverage, limitations, and payment provisions. Medicare Part A covers hospital, home health and rehabilitation services. As long as you are eligible to receive Social Security retirement benefits, there is no premium for Part A coverage, and generally no co-pays or deductibles.
Medicare Part B covers doctor visits, ambulance services, and durable medical equipment. There is a monthly premium paid for Part B coverage, and that premium is based on annual income earned two years prior to the current year. So, those who were higher income earners in 2011 will pay an additional premium above the standard $104.90 monthly premium. Medicare Parts A and B are generally provided in tandem.
Both Part A and B are financed through income taxes paid by employers and employees, and the payments to providers comes from directly from government funds. Medicare Part C (“Medicare Advantage”), however, is a quasi-private plan in that private companies provide the coverage, with the providers receiving government funding. Part C covers most medical services and is a “managed care program,” like an HMO. This means that you are limited to the providers from whom you can receive services and you need to get referrals before you can see a specialist. Conversely, Medicare Parts A and B are “fee-for-service” plans that do not have those constraints. Medicare Part C plans usually cover more services, lie wellness, eyeglasses and hearing aids; however, coverage is more limited for more intensive coverage like hospitalization. If you ever need more extensive coverage and want to change to Parts A and B, you will have to pay a 10% premium penalty. Approximately 25% of Medicare beneficiaries participate in a Medicare Part C plan.
Medicare Part D covers prescription costs and is, again, offered through private companies. Coverage, premium amounts, and deductibles vary. Medicare Part D coverage is additional to A and B or C, and it is not required. You can enroll in a Part D plan at any age during the open enrollment period.
Medicare can be a confusing road to navigate. If your family is concerned or has questions about Medicare, seek legal advice from a competent Elder Law attorney. Legacy Law Firm, LLC is located in Sandwich, Illinois and focuses on elder law and Life Care Planning for clients. The office may be reached by calling 815-570-2334 or email at email@example.com.