THE ABCD’S OF MEDICARE

THE ABCD’S OF MEDICARE

Thomas J. Flannery, MD MBA, a Tepsick Independent Insurance Agent

Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD) or ALS (Lou Gehrig disease).

Every day 10,000 baby boomers turn 65. Those with their 65th birthday this July were only 13 years old on July 30, 1965 when President Lyndon B. Johnson signed Medicare into law in Independence, Missouri and made former President Harry Truman the very first Medicare enrollee. In its first year Medicare had 19 million enrollees.  There are now 50 million+ enrollees.

Over the years Medicare has evolved as Congress has added new benefits and modified how hospitals and practitioners are reimbursed for their services.

There are four parts to Medicare:

Part A (Hospital Insurance) pays for part of an inpatient stay in a hospital or in a skilled nursing facility following a minimum 3 day hospital stay. If you receive or are eligible to receive Social Security Benefits, you can obtain Medicare Part A coverage at age 65 at no cost. We recommend that you sign up for Medicare Part A three months before your 65th birthday even though the Social Security full retirement age is no longer 65.  If you have employer provided health insurance, Medicare Part A can serve as a secondary insurer.

Part B (Medical Insurance) helps pay for physician services and services of other health care providers. Medicare Part B also provides benefits for outpatient care, home health care, durable medical equipment and some preventive services. Medicare Part A plus Medicare Part B are sometimes referred to as “Original Medicare.”  Since neither Part A nor Part B pay 100% of allowed charges, private insurers offer Medicare Supplemental Insurance to fill the gaps.

Part B enrollees pay a premium. Enrollment in Part B is limited to designated enrollment periods. If you do not enroll in Part B during the Initial Enrollment Period (3 months before, during, and 3 months after your birthday month) you will have later opportunities to enroll, but will be subject to a late enrollment penalty that lasts as long as you have Part B coverage. For those who still work and have employer based insurance, you can postpone enrolling in Part B and you will not be subject to a late enrollment penalty.

Part C (Medicare Advantage) provides all the services and benefits of Medicare Parts A and B. Some plans include prescription drug coverage and additional services and benefits. A variety of such plans are available.

Part D (Medicare Prescription Drug Coverage) helps defray some of the cost of prescription drugs. The Prescription Drug Benefit can be part of an Advantage Plan or added to “Original Medicare.” If you do not join a Prescription Drug Plan when eligible you may be subject to a penalty unless you have creditable drug coverage from another plan.

As an Independent Insurance Agent we can help you determine which mix of these options best suits your unique health needs and your health care budget.

If you need more information about the different health care options available, or if you are looking to make any changes in your health care plan, feel free to contact me at 607-346-6676 or tom@tepsickinsurance.com.

© 2017, Charles Montgomery. All rights reserved.

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