Learning the ABCs (and Ds) of Medicare
By Jay Nachman
Pennsylvania has nearly 2.8 million Medicare beneficiaries, according to the American Association for Medicare Supplement Insurance. If you’re reading this article, chances are you qualify for Medicare or will soon.
The process for obtaining Medicare coverage begins when a person turns 65. It is called the Initial Enrollment Period. This period lasts for seven months, starting three months before turning 65 and ending three months after the month of your 65th birthday.
There are two main ways to get Medicare:
- Original Medicare includes Medicare Part A (hospital insurance) and Part B (medical insurance).
- Drug coverage is provided through a separate Medicare plan, called Part D.
Medicare Part B covers many preventive and screening services to help older adults stay healthy. These services help detect health problems early, determine the most effective treatments and prevent certain diseases. Preventive services include exams, vaccines, lab tests and screenings. They also include programs for health monitoring, counseling and education. Medicare covers screenings for cardiovascular disease, cancer, glaucoma, as well as diabetes self-management training and a yearly wellness visit.
A list of preventive and screening services Medicare Part B covers can be found at www.medicare.gov/coverage.
Additional coverage
Medicare Advantage, known as Part C, offers an alternative to Original Medicare for health and drug coverage. These plans are approved by Medicare but offered by a private company instead of the government. Some Medicare Advantage plans may offer extra coverage, which can include:
- Transportation to doctor visits.
- Over-the-counter drugs that Part D doesn’t cover.
- Services to promote health and wellness.
- Customized benefits to treat specific conditions.
Medicare Supplement Insurance (called Medigap) is extra insurance from a private insurance company that works with Original Medicare to help pay a share of costs. It can be used anywhere in the United States that accepts Medicare. Under federal law, there is a one-time six-month Medigap Open Enrollment period. It starts the first month with Medicare Part B. During this time, recipients can enroll in any Medigap policy and will generally get better prices and more choices. After this period, beneficiaries may not be able to buy a Medigap policy, and it may cost more.
Medigap policies do not include prescription drug coverage. They also generally don’t cover longterm care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.
What to consider
According to the HealthCare.gov website, there are three things to know before picking a health insurance plan.
There are four categories: Bronze, silver, gold and platinum. These categories show how beneficiaries and a plan share costs. Plan categories have nothing to do with quality of care.
Beneficiaries pay a monthly bill to an insurance company, called a premium. This payment is required, even if a beneficiary doesn’t use medical services that month. Beneficiaries pay out-of-pocket costs, including a deductible, when they get care. It is important to think about both kinds of costs when shopping for a plan.
Some plan types allow beneficiaries to use almost any doctor or health care facility. Others limit your choices or charge you more if you use providers outside their network.
Need help?
Older adults with low incomes can determine online if they can qualify for Medicaid, which helps cover medical costs for individuals with limited income and resources. This website also explains who to include in a household and how to estimate income: www.healthcare. gov/lower-costs.
Medicare Savings Programs help with Medicare Part A and B costs. If you have limited income and resources, you may qualify for one of these programs. It could save you more than $1,900 each year, according to Medicare. These programs are administered by the Pennsylvania Department of Human Services. You can apply online at www.compass.state.pa.us or by phone at 1-866-550-4355.
Extra Help is a Medicare program to help people with limited income and resources. It works with any Medicare Part D prescription drug plan to lower the costs of premiums and prescription drug costs. If you have limited income and resources, you may qualify for Extra Help.
If you’re confused about your Medicare options, Pennsylvania Medicare Education and Decision Insight (PA MEDI) can help! This statewide service is operated by the Pennsylvania Department of Aging. Philadelphia Corporation for Aging (PCA) is a trusted local resource for Medicare help. All services are free, confidential and provided by specially trained certified counselors. For more information about PA MEDI, see page 4 or call the PCA Helpline at 215-765-9040. The toll-free statewide PA MEDI Helpline is 1-800-783-7067.
Jay Nachman is a freelance writer in Philadelphia who tells stories for a variety of clients.
