The Medicare Alphabet
Navigating Your Federal Healthcare Options
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.
However, Medicare itself offers a very informative website (www.medicare.gov); clear, concise publications that 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. (See resources on page 16 for help.) 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.
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 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, 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.
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 11 types of supplemental policies offered in North Carolina–A, B, C, D, F, F Prime, G, K, L, M and N. 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.
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. You will 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 point 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.
Here are three Medicare resources that are easy to access
This website offers clear explanations of the Medicare program, updates on changes, and answers to frequently asked questions. It also offers Medicare & You for download to your computer or e-book reader or as an audio podcast. You also can request that information be mailed to you in print form or on an audio CD. Within this invaluable reference is everything 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.
At the end of this helpline is someone well trained to help you with any Medicare question or issues.
Seniors’ Health Insurance Information Program (SHIIP)
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 contact information for SHIIP programs in our area:
In Buncombe County
828-277-8288 (ask for SHIIP help)
Council on Aging of Buncombe County
46 Sheffield Cir, Asheville
In Henderson County
828-277-8288 (ask for SHIIP help)
Blue Ridge Health’s Hendersonville Family
709 N Justice St, Hendersonville
Council on Aging for Henderson County
105 King Creek Blvd, Hendersonville
- SHIIP help is offered here one day a week
In Polk County
828-749-9245 (ask for SHIIP help)
Saluda Senior Center
64 Greenville St, Saluda
The Meeting Place
75 Carmel Ln, Columbus
In Transylvania County
828-884-3109 (ask for SHIIP help)
Transylvania County Cooperative Extension
98 E Morgan St, Brevard