Understanding the Different Parts of Medicare
Medicare is the federal medical insurance program offered by the United States government. Most New Yorkers are eligible for Medicare when they turn 65, but some may apply and collect benefits earlier if they have qualifying disabilities or medical conditions.
The Different Parts of Medicare
- Part A. Under Original Medicare (Parts A and B), you can go to nearly any doctor or hospital in the country, and the government will pay for your health care services directly. Part A pays for inpatient hospital stays, short-term home health or nursing care, and hospice care. You do not need to get prior authorization from a primary care doctor or your insurance company. You can go directly to the doctor or hospital when you need care, with the bonus that there are limits on the amount that doctors and medical institutions can charge you.
- Part B. Part B covers your medically-necessary outpatient medical services. These include doctor's visits, emergency room treatment, yearly health screenings, preventative services, and certain medical equipment. In most cases, you will be responsible for paying a monthly premium for Part B.
- Part C. You will be automatically enrolled in Part A and B benefits through Original Medicare upon approval, but you can easily switch to a private Medicare Advantage Plan (also called Part C). Medicare Advantage plans are required to provide all Part A and Part B services covered by Original Medicare, but they could also be bundled with other benefits, such as dental insurance, vision care, hearing testing, or prescription drug coverage. These plans are similar to traditional private health insurance policies because they have different rules, costs, and network restrictions that can affect where you receive care.
- Part D. Medicare Part D is an optional prescription medication coverage offered through private insurance companies. This insurance has a separate premium from your Original Medicare coverage. You will have to carefully compare Part D plans to see if the medications you take are covered; otherwise, you may have to request an exception or pay out of pocket for some prescriptions.
- Medigap. Medicare Supplement Insurance (or Medigap) policies help pay for costs not covered by Original Medicare, such as coinsurance, copayments, deductibles, or medical coverage while overseas. Depending on the policy offered, Medigap plans may also be referred to as Medicare Part E or F. Medigap is only for Original Medicare and cannot be used to pay for anything related to Medicare Advantage.
Will I Need Medicaid Benefits in Addition to Medicare?
It depends on your situation, but you would do well to protect your eligibility for both. For one thing, Medicare specifically does not cover nursing home care—even though it covers short-term hospital or recovery center stays. However, Medicare eligibility kicks in automatically at age 65, allowing you to pay medical expenses decades before you need long-term care.
While comparing the various Medicare insurance offerings may be confusing, performing Medicaid planning is considerably more challenging. Unfortunately, many people only begin planning for Medicaid shortly before they need it, losing thousands of dollars in Medicaid penalties. It is essential to understand your Medicare coverage choices and your Medicaid requirements as early as possible to avoid paying high out-of-pocket costs and ensure that your loved ones’ inheritances aren’t sacrificed to pay for your medical care.
If you need help getting Medicaid or Medicare benefits to pay for long-term care, the elder law attorneys at Landskind & Ricaforte Law Group, P.C. can advise you on the best plan for the future. Contact us today through our online form or by calling 718-333-5007 to get started.