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Medicare Basics

Medicare A
Medicare Part A insurance helps pay for "medically necessary" care that involves an inpatient stay in the hospital.  Part A also helps pay for a stay in a skilled nursing facility as a follow-up to a hospital stay, hospice care for the terminally ill, and some skilled home health care for the homebound.  Part A also helps pay for some blood transfusions.

There are coverage limits if you are hospitalized more than 90 days at one time.  There are also limits to the number of days that Part A will cover and the number of days in a skilled nursing facility.  However, Part A pays for an unlimited number of skilled home health care visits or hospice care visits, but you must meet certain conditions to receive either kind of help.

Enrollment Rules for Medicare A:
As soon as you become eligible for Medicare you can join Part A.  Automatic enrollment if you are currently receiving Social Security benefits when you turn 65.

Medicare B

Medicare Part B insurance helps pay for "medically necessary" care.  This includes doctor visits, care in  hospitals and clinics when you are not admitted for an inpatient stay.  Laboratory tests,  some diagnostic screenings, and some skilled nursing care at home are covered.  Part B is voluntary.

There are coverage limits on the amount Part B will pay in a calendar year for occupational and speech therapy. 

Enrollment Rules for Medicare B:
As soon as you become eligible for Medicare you can join Part B.  You can also join Part B later, but only at certain times of the year, unless you qualify for an exception, such as working past age 65 and have current employer coverage.  If you are receiving Social Security benefits when you turn 65 you will automatically be enrolled unless you refuse coverage.

Medicare C
Medicare Part C plans are referred to as "Medicare Advantage" plans.  All these plans are run by private companies.  They combine coverage for hospital stays and doctor visits.  You can choose plans with prescription drug coverage often at no additional premium.  Plans are also available without prescription drug coverage.

All Medicare Advantage plans have "service areas".  These are areas where they offer coverage.  Generally, you must live in a plan's service area in order to join.  Plans must offer nationwide coverage for emergency care, urgent care and renal dialysis.

There are a variety of plans:  HMO, PPO, MSA, and PFFS to name a few.

Enrollment Rules for Medicare C: 

You can join as soon as you become eligible for Medicare A and B.  You can only join at certain times of the year,  unless you have an exception.

Medicare Supplement

Medicare Supplements or Medigap policies are sold by private companies that pay costs that Part A and B don't cover.  There are 10 Standard plans labeled "A through N". 

Medigap policies are not government benefits like Medicare A and B.

All Medigap policies provide an additional 365 days of hospital care during a lifetime, beyond the Medicare lifetime reserve.  Some policies offer coverage for emergency care outside the United States.

Enrollment Rules for Medicare Supplements:
You can apply for a Medigap policy at any time after you reach 65 and join Medicare Part B.  Medicare guarantees the right to buy any policy during the six months after you turn 65 called open enrollment period.  The carrier can't consider your medical history or current health in setting premiums.   However, a carrier may be able to make you wait 6 months before coverage begins for a pre-existing condition.

Medicare D
Medicare Part D helps pay for prescription drugs.  It is not automatic. All these plans are run by private companies.  You can buy a separate policy just for prescription drugs or you can buy some types of "Medicare Advantage" plan that includes drug coverage.

 If you delay signing up after you are eligible, you may pay a penalty on your premium, unless you qualify for an exception.

The Federal Government has created guidelines for the types of drugs covered and set minimum standards of benefits.  Medicare Part D plans must meet these standards.  Not all plans are the same.  They vary in cost and drug coverage.

Enrollment Rules for Medicare D:
You can join if you are entitled to Medicare A or enrolled in Medicare B.  You can only join at certain times of the year, unless you have an exception. 

Regence BlueShield of Idaho is an Independent Licensee of the Blue Cross and Blue Shield Association.pacific sourceblue cross boiseselect healthbridgespan