Medicare Made Simple

April 23, 2008 by  
Filed under ALZHEIMER'S

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In battling healthcare issues in general and Alzheimer’s disease specifically, it’s important to know and understand Medicare and/or your private insurance coverage. 

What is Medicare?  Medicare is a government program that provides healthcare insurance coverage for Americans who are 65 years of age and older.

Medicare, like most insurance, does not pay 100% of medical costs. 

Medicare pays about 50% of medical costs for seniors.

In general, Medicare pays for: 

  • Hospitalization, doctors, some nursing care, some prescription drugs, and medical equipment and supplies.

Medicare has four main parts: A, B, C & D

  • Part A includes coverage for hospitalization, some skilled nursing facility/home health care, and hospice (someone has called hospice, the best kept secret in Medicare.  I am planning a series of posts on this important coverage)
  • Part B includes coverage for doctor’s services and outpatient care including: X-rays, lab work, physical and occupational therapy, some home health care and some preventive screenings.
  • Part C (sometimes called Medicare Advantage) is Medicare received via an HMO (Health Maintenance Organization), which is a privately managed care system.  Coverage can also be received through a PPO (Preferred Provider Organization). 
    • The important aspect of this plan is that it includes all of the benefits of Parts A and B as well as some additional coverage from the private plan.
    • The caveat of this plan is that it limits WHERE and HOW members receive care
  • Part D consists of private insurance plans that partially cover prescription drug costs.

Who is Eligible

In short, citizens or permanent residents of the United States who are 65 years of age or older qualify for basic Medicare benefits.

Eligibility for Part B coverage-All United States citizens and legal residents over 65 years old are eligible.  If, however, a person has been receiving Social Security disability for two years OR has a chronic kidney disease, they may also be eligible. 

How Do You Enroll for Medicare?

Parts A and B

If a person is receiving Social Security benefits of any kind, they will be automatically enrolled in Parts A and B. They should receive Medicare enrollment cards and information in the mail three or so months prior to their 65th birthday.

If it doesn’t happen automatically, then you can go to the local Social Security office and sign up.

You can also go to the Medicare site and complete the online enrollment form.

Parts C and D

These are optional coverages and enrollment is handled via the specific HMO or PPO that they want to be enrolled in.

Here are a few resources to help you along the way as you deal with Medicare information gathering and enrollment. (click on medicare)

Information for this post was gathered from the above links and my personal experiences.

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NOTE: The contents in this blog are for informational purposes only, and should not be construed as medical advice, diagnosis, treatment or a substitute for professional care. Always seek the advice of your physician or other qualified health professional before making changes to any existing treatment or program. Some of the information presented in this blog may already be out of date.

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