The ABC & D of Medicare

Medicare is complicated but not impossible to understand.

It does have numerous parts and add-ons and the details of that policy you so carefully selected can change from year to year, along with the premium.

ABCD of MedicareHowever, Medicare itself offers a very informative website (www.medicare.gov); clear, concise publications you can download or have mailed to you; toll-free numbers for your questions; and real, live Medicare counselors in a town near you who can walk you through the entire process. But before you make contact, here’s a quick overview of Medicare—what it is, its parts, and how those parts work together or not—so you know what specific questions to ask.

The Basics

Medicare is a federal health insurance program for people who are 65 years old or older. Some people with certain disabilities or diseases qualify for Medicare before they reach 65 years of age. Check the Medicare resources at www.medicare.gov for details.

Medicare Parts

Medicare is available in four parts—A, B, C, and D—each with its own level of services. And then there is Medicare Supplement Insurance or Medigap, which is not Medicare but a private policy that works with your Medicare policy to supplement your healthcare costs.

  • Medicare Part A, in general, covers hospitalization, skilled nursing, hospice care and some home-health services. This part is offered through the federal  government with no premiums for most American citizens.
  • Medicare Part B pays for physician’s services, outpatient care, medical supplies and some preventative screenings and services. This part is offered through the federal government and is combined with Part A. Part B does have premiums.
  • Medicare Part C is also known as Medicare Advantage Plans. These plans are offered through private insurance companies and premiums are charged. These companies contract with Medicare to provide Medicare A and B benefits, plus benefits and services not covered under A and B. For instance, many Part C plans offer prescription drug coverage (so if you have your Medicare through Part C, you won’t need Medicare Part D). With Medicare Part C, you typically are part of a Health Maintenance Organization (HMO), a Preferred Provider Organization (PPO), a private fee-for-service plan, a special needs plan or a Medicare Medical Savings Account Plan.

  • Medicare Part D covers prescription drugs. It is an add on to Parts A and B. As with Part C, Part D is offered through private companies approved by Medicare and there is a premium. Note: There is a penalty if you do not have a drug plan.

Supplemental Insurance

Medicare Supplement Insurance or Medigap Policies are sold by private insurance companies and are meant to supplement Original Medicare, also known as Parts A and B. There are ten types of supplemental policies (A, B, C, D, E, F, G, K, L and N). However, not all types are sold in every county. Companies that sell supplemental policies must offer type A, C and F. Go to www.medicare.gov to find out what is covered in each policy type.

Medicare Help

Newer supplemental policies do not include prescription drug coverage. So if you want such coverage, you need to sign up for Medicare Part D or a supplemental plan with drug coverage. Note that if you have Medicare Advantage Plan (Part C), it is illegal for a company to sell you a Medicare Supplement Insurance policy. So you need to choose whether Medicare Advantage Plan (Part C) or a supplemental policy best suits your needs. You can find a full explanation of Medical Supplemental Insurance versus Medicare Part C at www.medicare.gov. There you can also find companies licensed to sell these policies in North Carolina, as well as explanation of the coverage and costs of each plan.

Which Medicare parts you choose and your benefits and cost are highly specific to your personal situation. The most important information to impart about Medicare is that you do not need to figure this insurance out on your own. Help is everywhere and easy to access. Take advantage of it, and enjoy the confidence that comes with having the right healthcare coverage for you.

Medicare HelpHere are three Medicare resources that are easy to access

  1. www.medicare.gov
    This website offers clear explanations of the Medicare Program, updates on changes, and answers to frequently asked questions. It also offers informational documents you can download to your computer or Kindle or that can be sent to you by mail. Within this invaluable reference is every thing you need to know about Medicare and supplemental policies, along with easy to read charts that allow you to compare and contrast parts, policies, and benefits.
  2. 1-800-MEDICARE
    Call this helpline to speak with someone well trained to help you with any Medicare question or issues.
  3. Seniors' Health Insurance Information Project (SHIIP)
    www.ncdoi.com/shiip

    855-408-1212
    Each county in North Carolina has its own SHIIP counselors specially trained to help you with your Medicare questions. You may speak with them by phone or set an appointment to meet in person. Here is the contact information for the SHIIP program nearest you:

Buncombe County (Ask for SHIIP Help)

Council on Aging of Buncombe County 46 Sheffield Circle
Asheville, NC 28803
828-277-8288

Henderson County (Ask for SHIIP Help)

Pardee Signature Care Center
Blue Ridge Mall
1800 Four Seasons Blvd.
Hendersonville, NC 28792
828-692-4600

Polk County (Ask for SHIIP Help)

Saluda Senior Center
64 Greenville Street
Saluda, NC 28773
828-749-9245

or The Meeting Place

75 Carmel Lane
Columbus, NC 28722
Call 828-749-9245 for an appointment

Transylvania County (Ask for SHIIP Help)

Transylvania County Cooperative Extension
98 East Morgan Street
Brevard, NC 28712
828-884-3109

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