subject: Coverage Options In Medicare Parts A, B, C And D [print this page] Medicare serves as a social medical insurance plan managed by the Federal Government to help support the health costs of the senior citizens of America (65+). Regarding men and women under 65 years, those with permanent disabilities and renal failure, who need dialysis etc, can certainly sign-up for Medicare as well.
Medicare insurance coverage mainly is dependent upon the Part of Medicare that one registers for. 90 days prior to a person's 65th birthday, one receives a Medicare card, which actually establishes that an individual has Medicare insurance coverage. After becoming 65, one automatically becomes entitled to Medicare. Nevertheless, s/he needs to enroll for Medicare in the open signing up period, that is right from November 15th up until December 31st. Upon enrolling for Medicare one receives direct access to Medicare Part A (Hospital Insurance), that is free of cost, which means no premiums to be paid. Anyone who is eligible for Part A automatically will become eligible for Part B (Medical Insurance) also. Having said that, if s/he already receives social security, Medicare Part B might not be required, it could be opted out of by simply following guidelines on the Medicare card.
Medicare includes four categories, if one has one or a combination of all of these, s/he could get the following insurance coverage for every Part.
Considering that Part A is referred to as Hospital Insurance, it insures all of the in-patient hospital expenses. For instance, hospice care and interval term in hospice care, blood transfusion (with the exception of three pints yearly), home heath care treatment, however, not adult supervision, long-term hospital care, although, till 60 days of hospital stay; immediately after 60 days the coverage decreases; upon crossing 150 days, the insurance coverage stops. Also, it covers obesity bariatric surgical treatments, costs borne by the policy holder on going to a non-medical health care organization that works on religious grounds, skilled but not private nursing facilities, room services in hospitals excluding TV and VCR in rooms, medical equipments and other such supplies etc, social services, chemotherapy, prescription drugs , anesthesia, conveyance, regular meals, laboratory tests and the like.
Next comes Part B or Medical Insurance. If one chooses to keep this Part then s/he will get coverage on medical expenses and most things that Part A fails to cover. Part B covers 80% of the medical bill and the rest 20% is to be borne by the beneficiary. This 20% is the co-insurance or the co-pay that the beneficiary pays, and of course, there are deductibles too. The medical expenses falling under Part B are outpatient doctor's/physician's services, medical and surgical services, glaucoma tests, ambulance conveyance, mental illness, prosthesis, bone mass density measurement, radiation treatments, breast cancer and other cancer screenings, diagnostic tests, cardiovascular tests. It also covers Mammograms, emergency room treatment, radiology and pathology treatment. Unlike Part A, Part B has its premiums for the beneficiaries to pay. The residual 20%, that the beneficiary has to pay could turn out to be an amount that might come to be far from affordable at times. Here there is an option known as Medigap. Medigap plans are Medicare supplement plans that are sold by private insurance companies. These help pay for the expenses that Medicare does not pay for. There are 12 supplement plans that provide different types of coverage and charge different premiums too.
If a person wishes to enroll in to Medicare Part C, s/he must be eligible for both Part A and B. However, Part C plans are more like a combination of Part A and Part B. These are also known as Medicare Advantage Plans, also sold by Medicare approved private insurance companies. There are a number of Advantage plans to choose from, so many that it might confuse the buyer. These plans offer additional benefits at lesser costs as compared to Medicare originally. Also, known as managed care, they include Medicare Health Management Organisations (HMO), Medicare Private Fee For Service (PFFS), Medicare Medical Savings Account (MSA) and Medicare Special Needs, Medicare Preferred Provider Organisations.
Part D plans i.e. prescription drug plans allow the beneficiary to claim a section of the cost of prescription drugs' cost, to paid by Medicare. Anyone who is eligible for Parts A, B and C gains eligibility for Part D not considering his/her health history and amount if income earned.
This is what all Medicare covers for its beneficiaries. For all those expenses ignored by Medicare, Medigap and Medicare Supplement Plans come to the rescue.
by: Pete Baker
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