Medicare may appear simple to those who have used it for a long time. But for anyone who is new to the program, it can be difficult to fathom, especially with information about it coming from different sources.
That’s why many people get confused and fail to understand even the basic concepts of the program. However, you can learn how the program operates as you continue to use it.
The plan has been broken down into four different parts to make it easier. Each part comprises several things such as prescription of drugs, doctor visits, and hospital care among others.
Part A – Hospital coverage
When a person applies for Medicare, they are automatically placed under the Part A plan. The first part of the program caters to hospice care, hospital stays, and other skilled nursing services that a patient may need after being hospitalized.
In most cases, you won’t be required to pay a premium while under this program. This is because you already paid it on your paycheck under the care deductions. But wait – part A isn’t absolutely free.
The program charges exorbitant deductibles every time a patient is admitted to a hospital. The charges change annually but the deductible for 2021 is $1,484. Alternatively, you can purchase a Medigap policy to take care of the deductible and other medical expenses.
Part A pays for almost everything for the first 60 days of hospital admission and treatment. However, there are some exceptions that the program won’t cover. For example, if you opt to be admitted to a private room, you will have to pay from your pocket.
In case you are a permanent resident of the United States, you have the option of getting enrolled by purchasing part A premium option if you are not part of it yet.
Part B – Doctor and outpatient services
Part B of the plan caters for lab tests, doctor visits, medical equipment, ambulance transportation, diagnostic screenings among and other services charged by outpatient facilities. Part B is much better than part A because it covers more costs.
If you are still working and your employer is offering you insurance or you are part of your spouse’s insurance plan, then you would want to postpone signing up for this plan.
But if you fail to sign up for part B and don’t have any insurance coverage, you will end up paying more in terms of monthly premiums – provided you are enrolled in the plan.
The federal government is the one that dictates the amount to be paid as part B monthly premiums. For the year 2021, the set amount is $148.50. The figure is likely to go up if you earn anything above $88,000.
Besides, members are also subjected to yearly deductibles. The 2021 premium amount is $203. But you will be required to pay at least 20% of the expenses accruing from doctor visits plus other outpatient services.
In case you earn Social Security benefits, the monthly premium will automatically be deducted from the benefits. You will see the exact amount that has been deducted from your financial statement.
Part C – Medicare Advantage (MA)
This is alternative private health insurance to the previous program run by the federal government. Think of it as a one-stop-shop that brings together different parts of the program into a single plan.
If a person chooses the MA plan, he or she will still be required to register in parts B and A as well as pay the premium charged in part B. They will then have to select an MA plan and register with a private insurer. Also, some people who qualify might get Medicare part B premium reimbursement.
The federal government mandates that these plans cater to everything that was previously covered by its earlier program. In recent years, the regulator has permitted MA to cover extra services and equipment such as shower grips and wheelchair ramps.
In general, it can take some time for those new to the program to understand it fully. It is important to look for information from the federal government and other credible sources.