If you’re reading this article, you or a loved one have probably become eligible for Medicare Health Coverage. Medicare is very different from what you may be used to in the employer sponsored market for health insurance, but there are options available that can provide you with very comprehensive coverage. To help you better understand Medicare, let’s talk about the different parts. For the sake of keeping things simple, I’m only going to talk about 3 parts, Medicare Part A, Part B, and Part D.
Medicare Part A provides coverage for Inpatient Hospitalization, Skilled Nursing Care, Hospice Care, and Home Health Care. Most people won’t have to pay a premium for Medicare Part A, but there is a deductible that you would be responsible for paying.
Medicare Part B covers physicians services and other outpatient treatment like labs, xrays, flu shots, mammograms, colonoscopies, etc. Although most people don’t have to pay a premium for Part A, Part B does require a premium. The amount an individual will pay for their part B premium is based on their income. In addition to the premium cost, Part B also has a deductible that will have to be met before any benefits are paid. Once the deductible is met, Medicare will pay 80% of the allowed amount for covered services. You, the beneficiary will be responsible for the other 20% plus any excess charges (link to what are excess charges article).
In 2006, Medicare Part D was established, and it provides drug coverage options for Medicare beneficiaries. Each Part D plan has a list of covered drugs called a “formulary”. Medicare beneficiaries must pay a premium for a Part D plan and most plans include copays and deductibles that the member would be responsible for paying. Before you decide to enroll in a Part D plan, be sure to review the plan’s drug formulary to be certain the drugs you take are on the list and determine what your out of pocket costs would be associated with those drugs.
If you have questions about Medicare that were not addressed in this article, let’s schedule a phone call to review your specific situation.