Medicare in Plain English (page 1)

Medicare is an important part of your life. But since the rules were written by the government, Medicare can be confusing and yes, frustrating. The Medicare Helpline is a private service that will help you sort it out. The Medicare Helpline is not a government service, so you can expect to get prompt service and helpful answers.

Our purpose here is to speak Medicare in plain English. Our aim is to make sure your rights in Medicare will actually result in you getting the health care you need, at a affordable level.

Over the next few days, the Medicare helpline will post vital tips on how to understand and use your Medicare benefits. Let’s start at the beginning.

Medicare is comprised of Parts A, B, C, and D. What do those mean? Medicare Part A and Part B are administered by the government. Medicare Parts C and D are administered by private insurance companies which contract with the government and abide by strict guidelines in what they provide.

Medicare Part A is the first of two government administered parts. In general, Part A covers hospital care, skilled nursing facility care, nursing home care (as long as custodial care isnt all you need), hospice, and some home health services. Medicare will usually cover a service if it’s considered medically necessary but it usually doesnt cover services that are elective, or cosmetic, or experimental. Medicare Part A premiums are usually covered by the taxes you have paid over the years you have worked, and so most people will not pay a Part A premium when they start receiving benefits.

Medicare Part B is the second government administered part. In general, Part B covers things like physician’s services, some mental health services (including inpatient, outpatient and partial hospitalization), durable medical equipment, ambulance service and some drugs (usually when administered by a medical professional). The same standard applies for Part B: Medicare will usually cover a service if it’s considered medically necessary but not if it’s otherwise. Part B premiums are not free, and most people will pay a Part B premium when they start receiving benefits. However, people with low incomes may receive assistance from their state in paying for Part B.

Medicare Part C is administered by private insurance companies. Part C is often referred to as Medicare Advantage. These are medical plans in which a private company provides the Part A and Part B coverage that is available under government Medicare. These private plans are free to provide more benefits, but by law they cannot provide less than government Medicare. A Part C plan may also include Part D benefits. All Part C plans have a premium, but some carriers offer certain plans at premiums as low as $0. They can do this because they are contracted with the government, and they receive the money that the government would otherwise allocate for your care if you were only enrolled in Part A and B. Having a Part C plan doesn’t remove you from Part A and B, it simply transfers the responsibility for administering the benefits to a private company. The company in turn is regulated by government Medicare to be sure they provide at least the level of care the law requires.

Medicare Part D is also administered by private insurance carriers. Part D is outpatient prescription drug coverage (Rx coverage). It is available as a stand alone plan, or as a portion of a Part C plan, as mentioned above. Part D Rx plans vary in which drugs are covered and for how much, but they all have a minimum standard and financial targets that must be met. All Part D Rx plans have a premium. However, people with low incomes may receive assistance from their state in paying for Part D.

In our next blog entry, we will cover these in wider scope. For detailed answers to your questions, a licensed agent at the private Medicare Helpline can assist you and guide you thru comparing benefits and costs of available plans in your area at 1-855-MEDICARE or contact us via the web:

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