• The ABC’s of Medicare Coverage

    The ABC’s of Medicare Coverage

One of the most important parts of your retirement will be making sure you’ve planned well for the future. Understanding the medicare alphabet is an important part of this planning. These are the main components of Medicare coverage, from A-D.

Medicare Alphabet

It’s important to know that there are always exceptions that can be made to coverage. So be sure to stay acquainted with changes before, during, and after enrollment. Coverage is determined by:

  • Decisions by Medicare about coverage eligibility
  • Federal and state laws
  • Companies processing claims and review of coverage as medically necessary

Original Medicare Coverage- A & B

Part A

You can utilize Part A for hospitalization and skilled care in a licensed facility. You will also have benefits to use for home health and hospice if needed. This event-based coverage has limitations to its application within a nursing home or skilled care facility, and can’t be used for long-term or custodial care.  

You will most likely access this coverage for treating an unexpected illness or injury, and the rehabilitation following. In some circumstances, your condition may not improve to the point where you can return to living independently. 

In a situation such as this, you can expect your coverage to end and will need to plan to assume the financial obligation of your continued care. Many individuals who plan for the unexpected will have considered continuing care retirement communities or have purchased long-term care insurance. 

Part B

Part B coverage, often referred to as medical insurance, covers services that are necessary to diagnose and treat medical conditions. You’ll use this for outpatient services (like doctor’s visits), preventative care, lab tests, and some medications and medical equipment. 

Just as you’re likely to do now, it is always best to consult your physician and check first to ensure you’re treatment is covered so that you can avoid out of pocket expenses. Keep in mind your coverage can be dependent on where you reside.

Medicare Advantage

Now, this is where you’ll want to do some homework. Part C of Medicare (also called Medicare Advantage) is actually provided by private insurance companies. The federal government mandates that these plans cover all the basics of Medicare Part A and Part B, but they also offer added benefits. 

Part C

As you’ve just read, Medicare Advantage (or Part C) is an alternative to Original Medicare and covers the services of both A&B. But you also may have noticed that up until this point there hasn’t been any mention of dental, vision, hearing or prescription drug coverage. 

By choosing a Medicare Advantage plan you can get more of the services you need under one umbrella, you may even save on plan management headaches and cost. You’ll have to shop though! These are private insurance companies that set their own premiums, out of pocket costs, and rules for accessing providers, like referral processes and in-network requirements. 

Prescription Drug Coverage

Part D

While enrolling in Medicare Advantage can alleviate the need for a separate prescription drug plan, if you’ve chosen Original Medicare and still need this protection you’ll need to look at Part D. Part D isn’t actually managed by Medicare, but companies offering Part D coverage must be in contract with Medicare and follow set guidelines.

You need to be enrolled in Part A, Part B, or (in some circumstances) both to access Part D. There is an important component to Part D you should know. It can cost you if you delay enrollment in Part D. So make sure you plan ahead.

While we’ve covered the basics of the Medicare alphabet, it’s always wise to consult your physician or a plan navigator to make sure you’ve considered all possible needs for your future health. 

To continue focussing on staying healthy and well as you age, please enjoy this free A-Z guide we’ve created!

Twin Lakes is a continuing care retirement community in Cincinnati, Ohio, offering villa homes, apartments, rehab services and more. We’re focused on supporting the vibrant and active lifestyles of our residents so they can age well. For more information, contact Twin Lakes online or at 513-247-1300.

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