subject: Consumers Guide To Understanding Your Medicare Coverage [print this page] The American Medicare Plan is a large health insurance program operated by the Federal Government. It's primary purpose is to provide health insurance to Americans 65 years old and older. Established in 1965, it has grown and changed in years since then. It can be somewhat complex. Following is a brief guide to understanding your Medicare coverage.
There are several parts of Medicare. They each have their own rules. The are somewhat, but not completely, independent of each other. The next few paragraphs summarize each of the parts. Dollar amounts stated are for 2009 or 2010.
Medicare Part A covers hospitalization. It covers all but $1,068 of the first 60 days of hospitalization. It pays a declining portion of the costs for the next 90 days, and nothing after that. It will cover part of the costs for stays in a skilled nursing facility, under fairly strict conditions. People who have worked at least 10 years on jobs covered by Social Security do not have to pay for Part A. Others $254 or $461 per month, depending on their years of Social Security coverage.
Part B is medical insurance that pays for most expenses other than those related to hospital stays and most medications. Mobility scooters and breast prostheses for use after a mastectomy, and other medical equipment may be covered. Individuals with less than $85,000 or married couples with less than $170,000 of annual income pay $96.40 per month for Part B. Those with more income pay between $134.90 and $308.30 per month on a sliding scale.
Part C is commonly called Medicare Advantage. This optional part combines the other parts of Medicare with privately issued health insurance. The lack of uniformity of these insurance plans makes it impossible to summarize their costs and benefits. Medicare Advantage is popular with many people reaching Medicare age who already have health insurance coverage that they like. They can often convert their existing plans to Medicare Advantage with little or no change.
Optional Part D also has a lot of variability in coverage and cost. It consists of prescription drug plans created by private insurance providers. Part D can be a part of a Medicare Advantage Plan.
If you want coverage for expenses not covered by Medicare, you could consider buying a Medicare Supplement Plan, also known as Medigap. They generally cover Parts A and B, but newer ones can't cover Part D. If you have Medicare Advantage, you cannot have Medigap. The same goes the other way, if you have Medigap you can't have Medicare Advantage.
Hopefully this will give you a brief orientation to the pieces of Medicare. Obviously this is not attempting to cover everything. Fully understanding your Medicare coverage is often a major task.
by: Derrick Johnson
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