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Published September 22, 2008 05:54 pm -

Understanding Medicare coverage complicated


By Judy Benge
50-Plus

DEAR JUDY: I am trying to decide which Medicare coverage I will need. But, the information is so confusing I am having a tough time deciding. There are so many different types of plans that I am afraid I may not get the right coverage for my senior years.

Can you help me understand what I may need and what all these initials stand for? There are Medicare Part A, B, C, D, PPO, HMO, and on and on. If you could at least give me and, I am sure many others going on old-age insurance in the near future, a push in the right direction, it would be greatly appreciated.

ANSWER: You are absolutely correct. I used to believe officials could not make it more complicated, but I was so wrong. With the addition of the prescription coverage, I think the confusion factor has reached its ultimate confusion factor.

Let me give the newcomers to Medicare some guidelines on what is available in this column. I will expand in future columns on this subject to help seniors new to the Medicare coverage additional help.

The Federal government manages what is called the original Medicare plan which provides Part A and B. The Medicare prescription drug plans are run by insurance companies and approved by Medicare. There are also Medigap (the Medicare Supplement Insurance) policies to help pay for the added coinsurance and deductibles (called gaps) not paid through the Parts A and B coverage.

Medicare health insurance for eligible people ages 65 and older (and those under age 65 who are determined by law to be disabled are divided up into several parts.

Part A is the hospital insurance, which helps cover inpatient care in the hospital. It covers skilled nursing facility, hospice and home health care under certain conditions.

Part B is the medical insurance, which covers medically-necessary services. This type of care is doctors’ services and outpatient care. Certain preventive care is also covered to help maintain your health.

Part C is the Medicare Advantage Plans, which is an alternative plan for your health coverage. It combines Part A and B, and in certain cases Part D, which is the prescription drug coverage.

These plans are managed by private insurance companies approved by Medicare and cover medically necessary services. You must be aware when signing up for these plans that the companies can charge different copayments, coinsurance and deductibles for this coverage.

Part D is the prescription drug coverage. It helps pay for your prescriptions, but has limits. Once you reach a certain amount during the year, you will have to pay the bulk of your prescription costs.

One of the troubling aspects of these plans is that many seniors do not understand that each year the deductibles and copayments for these plans increase, meaning more money out of pocket. So, planning for the future is extremely important, especially if you are a senior with health problems that are ongoing.

My advise to all seniors is to enroll in the best plan for your health condition, but remember that as we age we are more vulnerable to unexpected diseases. So, do not just consider your present health, but take a look at your genetic background to see if you might develop a disease that would bankrupt your savings.

And, I advise all seniors to enroll in added policies. By that I mean sign up for the Medigap coverage and the prescription drug coverage. If you become seriously ill, you will want to be able to afford the best care and medications available.



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