Making Sense of Medicare

Healthcare issues consistently rank at the top of the nation's news. Most elderly have to decide when they turn 65 years old whether they will sign up for Medicare or not. Medicare rules state that you must sign up for Medicare when you turn 65 or pay a penalty in higher rates.

Even after joining Medicare, most people remain ignorant about their healthcare rights and responsibilities. The rules are difficult to understand and are in a constant state of flux due primarily to legislative rules, continuing regulation, and fee schedule changes.

Medicare Make-up

Medicare consists of two basic parts. They are Part A and Part B. There is a third part known as Part D drug coverage. There is a fourth part known as Part C that actually deals with a type of insurance plan called Medicare Advantage.

Medicare Part A

Part A helps cover your inpatient costs and covers fees charged by facilities like hospitals, clinics, ambulatory surgical centers, outpatient hospital facilities, home health agencies, skilled nursing facilities, etc. Generally, people automatically get Medicare Part A without paying any premiums because they or their spouse paid in Medicare taxes while working. if you don't automatically get premium-free Medicare Part A, you still may be able to purchase it under certain conditions.

Medicare Part B

Part B of Medicare covers fees charged by professionals. It's also known as "medical" because it covers the cost and administration of some drugs. It includes fees charged by doctors, anesthesiologists, labs, radiologists, dentists, audiologists, ophthalmologists, and other professionals, as well as those drugs covered by Medicare, durable medical equipment like wheelchairs, etc. Part B is optional. You normally pay the Part B premium every month. The premium can be higher if you didn't sign up for it when you first became eligible.

Medicare Part D

Part D of Medicare covers the cost of drugs not covered under original Medicare Part B. Private insurance companies approved by Medicare administer Part D drug plans.

Plans Administration

Part of the confusion regarding Medicare may stem from the fact that the government agency known by the public as Medicare contracts with many private insurance companies to administer Medicare benefits to Medicare enrollees through various insurance plans.

Medicare Supplement Plans

Some companies sell Medicare Supplement plans. Supplement plans typically cost more than other types of Medicare health plans. They actually pay some or all of what Medicare Part A and Part B don't cover depending on the specific plan, its benefit package, the State where it is located, and its service area. If you go to the doctor and you have a Medicare Supplement healthcare plan, your provider or doctor will send his bill directly to Medicare for payment; then Medicare will send the bill to your Medicare Supplement plan administrator (insurance company) for them to pay their share to your doctor.

Medicare Advantage Plans

Medicare Advantage plans are another type of popular Medicare insurance plan. These plans are typically very low cost and are subject to service area restrictions as well as private provider requirements. Not every healthcare provider accepts Medicare or Medicare Advantage plans. Medicare Advantage plans pay according to the Medicare fee schedule and pay additional service fees according to an enhanced benefit package. In other words, they provide an advantage over Medicare. So, where Medicare may pay a maximum for a particular service of, say, 80% of the Medicare allowed charges, some Medicare Advantage plans may pay as much as 90% for that same service.

These plans are typically primary insurance plans, which means your doctor will send their bill directly to your Medicare Advantage plan administrator (insurance company) instead of to Medicare.

Other Types of Medicare Health plans

There are other healthcare plans as well, like HMO's (health maintenance organizations) and PPO's (preferred provider organizations). They each have their particular characteristics and requirements. You should check into them very carefully and compare their benefits with different plan types.

Education is the Key

Learning more about Medicare is the only sure way to navigate these sometimes muddy and confusing waters. You can use several resources to find answers to your Medicare questions. Check out the Medicare website at www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227). You can also learn more about Medicare by calling or writing to your State Health Insurance Assistance Program. You can also register at MyMedicare.gov to track your health care claims, find information about your healthcare or prescription plan, check your deductible status for your Medicare Part A and Part B and find out many other tidbits of healthcare pertinent information.

Don't allow ignorance to prevent you from receiving the health care you need. Take advantage of the many resources available; become informed about Medicare and your health.

Your good health. It's up to you.

Some material for this article obtained from the official government handbook Medicare & You 2007