Becoming Medicare eligible brings with it a host of decisions that have to be made in short order. With all the available Medicare options, it can be difficult to get through the legal verbiage and understand which parts suit you best or if a Medicare Advantage plan may be right for you.
Original Medicare: Part A
Medicare Part A is also referred to as "hospital insurance." This Medicare Part covers the member for all approved inpatient treatment at a hospital, mental health center or skilled nursing facility. For those who have worked 40 quarters or more at a Medicare covered job over the course of their life, there is no premium for Medicare Part A. A member may also be covered if his spouse worked 40 quarters or more, or if she worked less than 40 quarters, but maintained a job for 10 consecutive years.
Original Medicare: Part B
Medicare Part B is also referred to as "health insurance." Part B is the coverage that is used when a member falls ill and has to see a doctor, requires outpatient surgery, needs a flu shot or needs diabetic testing supplies. Medicare Part B does have a premium. In 2009, the premium was $96.40 per month. If a member declines Part B coverage but later decides to sign up for Part B coverage, she will incur a penalty of 10 percent for every 12-month period she was eligible but not enrolled.
Original Medicare: Part D
Medicare Part D is prescription drug coverage. This is not offered on the regular Medicare plan and members will have to take Part D coverage through a private insurance agency. Like all other types of insurance, there is a premium to join Medicare Part D. This premium, along with the copayment and deductible, varies from plan to plan.
Original Medicare: Medigap
With Medicare, as with all health insurance options, there will be some out of pocket expense in addition to the premiums. This is where Medigap comes in. Medigap is designed to help cover "gaps" in Medicaid, such as copayments, coinsurance and deductibles. Medigap policies vary depending on the service area and the needs of the member.
Medicare Advantage
Medicare Advantage programs are a relatively new part of the puzzle. Medicare allows private insurance agencies to administer Medicaid programs, which allows the member a bit more freedom in his choices. Medicare Advantage plans are required by law to cover everything that Medicare covers, and most offer extra incentives such as more coverage for preventative care, some vision and dental coverage, and larger service areas.
Premiums for Medicare Advantage vary by provider. Many Medicare Advantage plans require no additional premium, or you can pay extra for more coverage. To be eligible for a Medicare Advantage plan, members must be enrolled in Medicare Parts A and B and be up-to-date on their premiums for both.
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