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Medicare, I’m Confused!

October 3, 2019

by Jen Harris, Communications and Outreach Manager 

Medicare is very complex and confusing. However, APPRISE, Pennsylvania’s State Health Insurance Assistance Program, and United Healthcare are helping to simplify the Medicare enrollment process.

What are Medicare Parts A & B?

Individuals can choose Original Medicare (Parts A & B) from the federal government, which the coverage and benefits are the same countrywide. Medicare Part A covers your hospital stays and associated services. Including but not limited to, care on special units, in-hospital medications and equipment, lab tests, X-rays, services received in the operating and recovery rooms and hospice care. You may have noticed this list does not include your care providers or the amenities you used during your stay.

Part B is your medical insurance. Part B pays for the care you receive during your hospital stay, wellness exams, necessary medical services, amenities, supplies and outpatient hospital services. Other services associated with Part B are preventative care (like flu shots), laboratory services, diagnostic testing, medical equipment, PT/OT and some in-home care services.

Individuals who are receiving Social Security or Railroad Retirement Board benefits will automatically be enrolled in Medicare Part A and Part B when they reach the eligible age. For those who need to register, the Initial Enrollment Period (IEP) is their first opportunity to choose the coverage they want. IEP lasts for seven months and includes the birth month or the 25th month of receiving disability benefits and includes the three months before and the three months after. Unless individuals qualify for a Special Enrollment Period, they may be charged penalties if they sign up for Medicare Part A, Part B, and Part D after their IEP period.

What Does Medicare Part C Cover?

Medicare Part C or also known as the Advantage Plan, combines Part A and Part B, aside from hospice care. Medicare Advantage plans are offered by approved private insurance companies. Many Part C plans incorporate prescription drug coverage and added benefits such as routine dental and eye care. Except in Massachusetts, Minnesota, and Wisconsin, standardized Medicare supplement insurance plans are the same throughout the country. While Medicare Advantage plans have a cap on the out-of-pocket costs for covered services, the Original Medicare does not. Individuals may purchase additional plans from private insurance companies to assist with deductibles and copays.

What Does Medicare Part D Do for Me?

Prescription drug coverage is not included in Parts A or B. Enrollment in Medicare Part D occurs at age 65 unless you have creditable coverage, or you will pay a monthly penalty that follows you forever. Make time to meet with a Medicare Counselor or visit to complete a drug plan comparison. Doing your homework ahead of time will help eliminate penalties and confusion in the long run.

Individuals should annually review their Medicare options. Regardless of the type of Medicare an individual chooses, individuals will be responsible for paying monthly premiums, deductibles, copays, and coinsurance fees.

For more information please contact the Chester County APPRISE office at 610-344-5004 (toll free 1-888-899-1001) to set up a time for a free, unbiased and confidential health insurance counseling session with a trained and certified volunteer.

Printed in the Daily Local News on Wednesday, October 3, 2018.

The Hickman does not endorse and is not affiliated with APPRISE, Medicare.Gov or United Healthcare. United Healthcare’s “Medicare Quick Tips: 8 key facts about Medicare” and information from was used for this article.