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Understanding Medicare


Medicare seems like a simple concept but just like social security, there are many rules and details that you should understand. First of all, the best place to go for answer is: https://www.medicare.gov  The website is very informative and where I go to if I need to research a Medicare question.

The major components of Medicare are Part A, B, C and D. Parts A, B and D combined are comparable to a PPO insurance plan while Part C is comparable to a HMO plan. You must sign up at age 65 to avoid a penalty but if you can prove that you were covered elsewhere the penalty is waived.

Part A is Hospital Insurance. It is designed to help cover the cost of your care in a hospital, rehab facility, and home health care for a limited period of 100 days per benefit period. There is no premium cost for Part A but there is a $1,288 deductible per year.

Part B is Medical Insurance. It covers doctor services, preventive and outpatient care. The premium cost for new enrollees is $121.80/month and your co-payment is normally 20% of the expenses incurred. The premium is deducted from your social security check but if you delay starting social security you must pay the premium directly to Medicare.

Part D is Prescription Drug coverage. This covers prescription drugs. This coverage is provided by an insurer that is approved by Medicare. To avoid a late penalty you should also sign up for this at the same time as part A & B. You can change the coverage in later years if the coverage is not enough.

Part C is medical insurance offered by private insurers. It is also known as Medicare Advantage. This is offered by HMO type insurers like Kaiser. Medicare deducts the cost of the insurance from your social security check and pays the insurer (e.g., Kaiser) for your benefit. Prescription drug coverage is normally covered as part of this plan too.

Next time, I will discuss medi-gap policies and Medicare premium amounts and what causes them to increase or decrease.

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