Understanding the ABCs of Medicare

Dave Ramstack
Dave Ramstack
Published on June 16, 2020

Medicare can be a tricky subject to understand, especially for seniors approaching retirement age that are mostly unfamiliar with the federal insurance program. It can definitely get complicated and confusing, so understanding at least the basics is helpful. 

What is Medicare? 

Medicare is a government insurance plan for seniors 65 and older, certain disabled people, and individuals suffering from end-stage renal disease. The program is administered by the Centers for Medicare and Medicaid Services, which is a division of the U.S. Department of Health and Human Services.

Medicare is considered an entitlement program (like Social Security), so citizens must work and pay their taxes in order to qualify for enrollment eligibility by time they turn 65. There are a few caveats to this, but in general that is how government entitlement programs function. 

What are the parts that make up Medicare? 

Medicare Part A

Inpatient hospital treatment

After being admitted into the hospital. Medicare Part A kicks in. Part A will cover up to 90 days in a hospital for each benefit period, plus 60 lifetime reserve days. 

A benefit period begins on day one of the patient’s hospital stay, and ends 60 consecutive days after discharge (as long as the person remains out of the hospital). 

Skilled nursing facility (SNF)

If someone has spent at least 3 consecutive days at a hospital, Medicare will cover up to 100 days at a skilled nursing facility and all associated care like therapy, tube feedings, and room & board. 

Hospice care

Medicare covers end-of-life care for terminally ill people for as long as their provider deems them eligible with a qualifying illness. 

Home health care

Similar to SNF requirements, a person can qualify for home health care with Part A after being admitted to a hospital for at least three days. If this requirement is not met, Part B can be used for different reasons. 

Medicare Part B

Part B of Medicare is for outpatient medical services and includes the following: 

  • Provider services/primary care
  • Durable medical equipment
  • Home health care (for homebound individuals)
  • Ambulance/emergent transportation 
  • Preventative care
  • Therapy (such as physical, occupational, and speech)
  • Mental health care
  • Medical imaging 
  • Lab work
  • Chiropractic care
  • Certain prescription drugs 

While this list shows common services covered by Medicare Part B, it is not an exhaustive list. Even though Medicare covers the cost of medical care, the insured will still be responsible for payments like coinsurance and copayments. 

Medicare Part D

Medicare Part D is the portion that covers most outpatient prescribed drugs. Part D is a little different in that it can be purchased through a private company, Medicare Advantage Plan, or as part of enrollment in Original Medicare.

Each Part D plan has a specific set of covered drugs called a formulary. Drugs not found on a specific plan’s formulary must be paid for out of pocket.

Types of drugs covered by Part D plans:

  • HIV/AIDS
  • Antidepressants
  • Antipsychotics
  • Anticonvulsants
  • Immunosuppressants
  • Vaccines
  • Anticancer drugs not covered by Part B

Despite being enrolled in a Part D plan, many seniors find it difficult to access affordable prescriptions. As an insurance agent, you can offer solutions for people needing more comprehensive drug coverage including: 

Enhanced Part D Plans 

Though enhanced plans might have higher monthly premiums than basic plans, they can offer low or no deductibles and broader coverage.

Medicare Advantage Plans (MA)

Also known as Part C of Medicare, a Medicare Advantage Plan is a private health plan not administered by the government. MA Plans can offer some benefits Original Medicare plans don’t have like dental and vision, but not always. MA Plans tend to have different rules and regulations, so it’s essential individuals understand their options completely before enrollment. 

Takeaway 

Medicare is a complex subject to understand. Seniors enrolling in Medicare plans could use the knowledge and expertise of an insurance agent to guide them through the often confusing process. As an agent, you can facilitate a smooth enrollment and address concerns for your clients. 

Interested in becoming an agent with us? Contact us today and learn why American Senior Benefits is a top choice for insurance agents looking to grow their careers.

The post Understanding the ABCs of Medicare appeared first on American Senior Benefits.

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