Parts, Plans and Prescriptions: Learning Your Way Through the Medicare System

Parts, Plans and Prescriptions: Learning Your Way Through the Medicare System

Medicare is a blessing for millions of older Americans, but understanding how to make the system work for you can take time. It’s important, though, because getting the coverage you need means knowing where to start and what’s best for you. Medicare is a fluid system and there are often changes, but the best approach to getting started is to take it a step at a time until you understand the terminology and where to look to ensure your healthcare coverage needs are being met.

The preliminaries

You’re officially eligible for Medicare three months to the day before you turn 65, unless you’re previously qualified due to a disability. You’ll sign up for Medicare through the Social Security Administration, which will be your primary point of contact for all questions and problems going forward. If you’ve already begun taking Social Security before age 65, you’ll be automatically registered for Medicare Part A, which covers care in clinics, hospitals and other facilities, as well as Part B, which pays for services from doctors and other care providers. Otherwise, it’ll be necessary to go through the registration process yourself.

Do some research

Bearing in mind your individual health needs, spend some time researching the different parts of Medicare so you know what plans you’ll need to enroll in. One important thing to remember is that Medicare has coverage gaps that you may need to fill by finding a supplementary plan. That’s where things can get a little tricky, especially if it’s all Greek to you, so doing some homework up front is worth the time in the long run.

The Parts

Medicare is comprised of different parts and it can be a little confusing trying to keep them all straight. If it helps, try thinking of Medicare Part A as covering medical facilities, and Part B as covering medical providers. Plan C is a bit different. It works like a private insurance plan providing an alternative to Parts A and B so that enrollees can find the coverage that meets their specific needs. Plan D offers prescription drug plans, an important piece of the pie considering the high price of prescription medication.

You can select original Medicare (A and B) or Part C (also known as Medicare Advantage). Advantage covers both Parts A and B and many Advantage plans also cover hearing, vision and dental coverage. Out-of-pocket costs may be lower with Advantage, though be aware that plans have a yearly cap on out-of-pocket costs, which means that when you’ve reached the limit you pay nothing for covered services the balance of the year.

If you need prescription coverage, you must join a Part D plan if you select original Medicare; if you’re enrolled in Medicare Advantage, you must get prescription coverage through that plan (in most cases). If you’re already enrolled in other prescription coverage (such as through work), you’ll need to find out how it will affect Part D coverage.

Supplemental coverage

If you choose Original Medicare and need help meeting coinsurance, copayments and deductibles, you can purchase a Medigap policy through a private insurer (Medigap is designed to fill some of the gaps in Original Medicare). However, Medigap doesn’t cover dental or vision, long-term care or private nursing. You may be able to retain plan coverage through someone else, like the government or an employer, along with your Medicare coverage. To sum it all up, you can add coverage with both a supplemental or Medigap policy, along with a Part D prescription policy; or you can go with a Medicare Advantage plan.

Where to turn

Reach out to Social Security for answers to questions about your coverage options or anything that’s not making sense, or visit Medicare.gov for useful information about navigating the Medicare system. You’ll find abundant information designed for individuals like you, who are are newly enrolled in Medicare but might not be very tech savvy. For Medicare Advantage plans, you can visit Medicare.org. Alternatively, you can find a Medicare adviser who can walk you through some of the steps necessary to find the right plan for you.

Applying for Medicare coverage can seem overwhelming but isn’t as difficult as you may think. Once you understand how the parts and plans work together, it all starts to make sense. And remember, there are plenty of online information tools to help guide your steps.

This is a guest post by Sharon Wagner. Sharon Wagner created SeniorFriendly to provide helpful advice to seniors on how to stay healthy and make the most out of life. She also wrote the book “The Ultimate Guide to Senior-Friendly Workouts, Fitness Gear, Healthy Recipes, and More.

Leave a Reply

Your email address will not be published. Required fields are marked *