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Medicare

Medicare is a federal program regulated by the United States Government, which provides health insurance for individuals who qualify. To be eligible for Medicare, you must be a US citizen or permanent legal resident for five continuous years, while having one of the following apply to you:

• You are 65 years or older and eligible for Social Security
• You are under 65, permanently disabled, and have received SSI disability payments for at least 2 years
• You receive continuing dialysis for permanent kidney failure or need a kidney transplant.
• You have Amyotrophic Lateral Sclerosis (ALS - Lou Gehrig's disease)
• You currently have Medicare Part A or Part B

Navigating Medicare can be a difficult process, no matter how much you think you may already know. Medicare was introduced to help people pay for the high costs of health insurance. The "Original Medicare Plan" is a fee-for-service plan that allows you to receive health care from any doctor or supplier who accepts Medicare. You are responsible for your deductible (cost prior to Medicare paying its portion), as well as the coinsurance or copayment costs. However, coinsurance and copays can be covered by Medigap plans or other supplemental plans. There are four parts to Medicare, A, B, C, and D. Part A and B are considered to be the "Original Medicare Plan". The (chart - table - etc) below will detail each part of Medicare so you will have a better understanding of what fits your needs.

Part A (Hospital Insurance)

Covers hospital stays (or skilled nursing facilities) if:

• Stay is for at least 3 days, not counting discharge date
• Nursing home stay is for condition that was diagnosed during the hospital stay or was the main cause of the hospital visit
• Receiving rehabilitation but has other ailments that requires nursing supervision (therefore nursing home stay would be covered)
• Nursing home care must be skilled. Part A does not cover care which is non-skilled, long term care activities or activities of daily living such as hygiene, cooking, and cleaning

There are restrictions to Part A coverage that stipulate a skilled nursing visit is covered for a maximum of 100 days (per ailment). During this time period, the first 20 days are covered in full by your Medicare plan, yet during the 80 remaining days you are responsible for a co-payment. Additionally, the 100 day clock resets only after the beneficiary goes at least 60 days without receiving skilled care.

Part B (Medical Insurance)

Part B covers some expenses that may not be covered by Part A, mostly associated with outpatient costs. Part B is optional and covers costs including but not limited to:

• Physician and nursing services
• X rays
• Laboratory and diagnostic tests
• Influenza and pneumonia vaccinations
• Blood transfusions
• Renal dialysis
• Outpatient hospital procedures
• Limited ambulance transportation
• Immunosuppressive drugs for organ transplant reciepents
• Chemotherapy
• Hormonal treatments

Part B also aids with the cost of durable medical equipment such as:

• Canes
• Walkers
• Wheelchairs
• Mobility scooters
• Prosthetic devices (artificial limbs, breast prosthesis, glasses following cataract surgery)

Part C

Part C of Medicare is also known as Medicare Advantage Plans. Originally coined, Medicare+Choice, these plans were introduced to give people on Medicare options when choosing their health insurance. Rather than having to be covered through Parts A and B, Part C allows private health insurance plans the ability to offer mirror coverage to Medicare. Medicare Advantage Plans can offer additional coverage to what Parts A and B provide, and can have lower deductibles and reduce payments in certain situations.

Part D

Part D of Medicare is also known as Prescription Drug Plans. These plans are regulated by Medicare, but are offered by private health insurance companies. Part D is not standardized like the other parts of Medicare, and be customized to cover specific drugs or classes of drugs depending on the person's individual needs. Anyone who is currently enrolled in Part A or B is eligible for Prescription Drug Plans. Prescription Drug Plans can save you money on your current medications, no matter the number of prescriptions you may take.

If you're looking for how to apply for Medicare, you may want to consider applying for low cost health insurance as it could provide better protection at a more affordable price.

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