Medicare has the primary responsibility to pay for health insurance for those who do not have any other insurance or coverage. The Medicare program has 4 parts to help meet the health and wellness of individuals; Part A covers hospital (free), Part B covers medical (premiums associated), Part C (Medicare Advantage), and Part D (prescription drug coverage). As previously mentioned in “What you need to know about Medicare Open Enrollment, Part 1”, to be eligible for Medicare Part C, you must have Part A and B, and Part D with Part A and/or Part B.
*Part A is the hospital insurance and it helps to cover the care of hospital stay, home health, hospice, and SNF (skilled nursing facility).
*Part B is the medical insurance and it helps to cover preventative services like screenings and shots, doctor visits, diagnostic tests, durable medical equipment like wheelchairs and walkers, outpatient care, and qualified therapies.
*Part C, also known as Medicare Advantage may help to lower out-of-pocket costs and provide additional benefits that Original Medicare (Part A and/or Part B) doesn’t. For example, some plans may offer vision, hearing, dental, gym membership or transportation.
*Part D is the Medicare prescription drug coverage that may help in lowering the cost of prescription drugs and protection against high-rising premium costs in the future.
Original Medicare does not cover long-term care, cosmetic surgery, hearing aids and exams, alternative medicine like acupuncture, and other services which leave some gaps in coverage for Part A and Part B. The alternative to Original Medicare are plans offered through Medigap that helps to cover your Part B bills. If you have a Medicare Advantage Plan (Part C) and previously signed up for a Medigap policy, you may want to drop the Medigap policy. Medigap policies cannot be used to cover Medicare Advantage Plan copayments, deductibles, nor premiums.
Medicare as the Secondary Payer
When signing up for Medicare, keep in mind that if you already have health insurance, the current insurance becomes the primary for health insurance coverage. In this scenario, Medicare will not have primary payment responsibility, thereby, becoming MSP (Medicare Secondary Payer) which will provide qualified coverage for services that the primary insurance does not cover. If you’re on a fixed income, you may want to weigh the pros and cons of switching to a Medicare Advantage Plan.
During Open Enrollment if you already have Original Medicare, you will have the opportunity to disenroll from Original Medicare and sign up for a Medicare Advantage Plan. You will also have the opportunity to switch from a Medicare Advantage Plan back to Original Medicare, enroll in Part D (prescription drug plan) or cancel your prescription drug plan and move from one plan to another.
DID YOU KNOW?
When you have limited income and resources to pay for health insurance and prescription drugs you can apply for Extra Help. To find out if you qualify, contact ssa.gov to find out more.
La-Villa Brooks, MPA is the founder of Brooks Home and Healthcare Management and is an Army Veteran. She has worked as a Project Leader for Local, State and Federal agencies in case management. She is a Certified Application Counselor for healthcare in the Marketplace, in addition to certifications with CMS (Centers for Medicare and Medicaid Services) and HIPAA. She is a member of GPNY (Gerontology Professionals of New York) and NAIPC Member (National Aging In Place).
All inquiries should be emailed to [email protected]