If you or someone you know is turning 65 in the next six months, it's time to take a comprehensive look at Medicare. Medicare is a type of health care insurance for Americans over the age of 65. If you are already enrolled in Medicare, it is wise to review your existing plan at least once a year, especially if your health has changed. If you live in New York and have questions regarding a health care plan, talk to one of our licensed insurance agents.
A Little History
When Medicare was first enacted in 1965, there were no Parts A, B, C, or D. There was just Medicare, which offered hospitalization coverage. Eventually, the hospitalization coverage became known as Medicare Part A. Over time, Medicare was expanded to include outpatient care, which became known as Part B. Parts A and B are often referred to as Original Medicare. Prescription drug coverage was added to Medicare coverage in 2006 and is referred to as Part D.
Part C is a recent addition to Medicare options. Part C covers the same services as Medicare Parts A and B but is offered through private insurers. Part C plans may include additional benefits such as vision, dental, and prescription drugs. Part C or Medicare Advantage Plans consolidate medical coverage under a single umbrella.
Every year, Medicare holds what is known as Open Enrollment. In 2020, Open Enrollment began on October 15 and will continue through December 15 for coverage starting on January 1, 2021. During the enrollment period, you can make changes to your coverage.
- You can change from Original Medicare (Parts A and B) to Medicare Advantage (Part C) or vice versa.
- You can switch from one Advantage Plan to another.
- You can change from one Part D plan to another.
If you did not enroll in Part D when you enrolled in Medicare at age 65, you can enroll during open enrollment. However, you will pay an annual late enrollment penalty along with any premiums.
If you are turning 65, you have six months from your date of birth to enroll in Medicare. You do not need to wait until open enrollment. Failure to enroll during the initial six months can result in financial penalties when you do enroll.
What Is Medicare Part A?
Part A was designed to help cover hospitalization costs for individuals over the age of 65. You do not pay a premium for Part A coverage if you worked and paid taxes for at least 10 years. If you worked less than 10 years, you must pay a monthly premium to receive coverage. The amount varies based on the years worked. Contacting Medicare is the best way to determine your premium.
Part A covers the following:
- Inpatient care in a hospital
- Skilled nursing facility care
- Hospice care
- Home health care
Part A requires a deductible and only covers a percentage of the charges, depending on the length of stay. In most cases, Part A covers 80% of hospital charges. See Medicare.gov for more information regarding Part A coverage.
What Is Medicare Part B?
Medicare Part B covers a wide range of medical tests and services. These services are divided into two groups:
- Medical services that are needed to diagnose or treat a medical condition.
- Health care services to prevent illness or detect an illness in its early stage when treatment is most effective.
No copay is required for preventive services if the health care provider accepts assignments. If Medicare does not cover the total charges, you are responsible for the balance.
Because of the numerous services covered by Part B, the best way to determine if the test or service is covered is to talk to your health care provider and Medicare. The amount covered through Part B depends on such conditions as:
- Whether the doctor accepts assignments
- Where the test or service is performed
- What other insurance coverage is available
You will also pay a monthly premium for Part B coverage. The amount is adjusted annually.
What Is Medicare Part D?
Medicare Part D is prescription drug coverage. It is an optional benefit available to anyone with Medicare. However, failure to select a prescription drug plan when you are first eligible at age 65 results in an annual late enrollment penalty.
Part D coverage is offered through a third party. Premiums are paid directly to the insurer. Although all Part D drug plans adhere to Medicare-mandated rules, the cost for drugs can vary by insurer and plan. You may also receive drug coverage as part of Medicare Advantage Plans (Part C).
To receive Part D coverage, you have two options:
- Register for Part A coverage and purchase a Part D plan
- Enroll in an Advantage Plan (Part C) that includes coverage for Parts A, B, and D.
If you purchase Part D coverage when you enroll in Part A, the company that manages the prescription drug plan bills you directly for monthly premiums. If Part D is included in a Medicare Advantage Plan, Part D premiums would be included in the cost of the Advantage Plan.
What Is Medicare Part C?
Part C or Medicare Advantage Plans provide the same coverage as Original Medicare or Parts A and B. They may include Part D coverage as well as hearing, vision, and dental coverage. Medicare Advantage Plans vary so it's important to look at exactly what additional services are provided.
With a Medicare Advantage Plan, your costs may include monthly premiums as well as deductibles and out-of-pocket expenses. That's why it is essential to evaluate all Advantage Plans to ensure that your healthcare needs will be covered.
We Can Help
Hamaspik Medicare Select is a Medicare Advantage Plan that serves as an umbrella for medical coverage. It combines Part A, B, and D coverage into a single plan with added benefits such as hearing, vision, and dental coverage. You pay nothing for these added benefits.
As a community-focused provider network, we understand the needs of the communities we serve. If you want the convenience of a one-stop provider for your medical care, contact us to discuss our New York Medicare Select plan. Let us be a part of making your life as healthy as possible.