Medicare is a government program that provides subsidized healthcare coverage for those aged 65+ years or people with disabilities. There are two kinds of Medicare: “original” Medicare (aka Medicare) and Medicare Advantage. Figuring out which plan is best suited for you can be challenging, so knowing the basics of each plan can help you choose wisely. Initial enrollment begins once someone turns 65. However, there are other deadlines and enrollment periods that are important to note. In this blog, we’ll give patients an overview of the Medicare and Medicare Advantage plans and the enrollment deadlines. If more information is needed, calling 1-800-Medicare or visiting the Medicare website (https://www.Medicare.gov/) can be helpful.
MEDICARE (aka original Medicare, Medicare part A and part B)
Original Medicare covers both Medicare part A and Medicare part B. Medicare part A is hospital insurance that covers in-patient hospital care, skilled nursing facility admittance, nursing home care, hospice care, and home health care. Medicare part B is the medical insurance component that covers doctors’ services, outpatient care, medical supplies, and preventative services. Additionally, there is a separate Medicare drug plan (part D) to get drug coverage. With original Medicare, you can see any doctor or hospital that takes Medicare. Also more likely than not, you won’t need a referral to see a specialist. On the flip side, Medicare does not cover vision, dental, hearing or retail prescription drug coverage and doesn’t have an out of pocket yearly limit.
MEDICARE ADVANTAGE (aka part C)
Medicare Advantage, sometimes called Part C or a bundled plan, covers Part A, Part B, and usually Part D. The Medicare Advantage plans are offered by Medicare-approved private companies that must follow a set of guidelines established by Medicare. Medicare Advantage has different types of plans to choose from such as: Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Private Fee for Service (PFFS), Special Needs Plans (SNP) and Medical Savings Account (MSA). These plans are explained below:
- HMO – a plan that provides health coverage in the plan’s network
- PPO is a plan that allows for the use of out of network providers.
- PFFS pays providers on a fee for service basis.
- SNP provides services to people with specific diseases or needs like chronic heart failure, autoimmune disorder, ESRD or Diabetes. Lastly
- MSA is a high deductible insurance plan with a medical savings account that you use to pay for your health care.
One benefit to having Medicare Advantage is its yearly limit on what can be paid out of pocket. Once you’ve reached that limit, you pay nothing for Part A and B services for the remainder of the year. Another benefit of Medicare Advantage is that it covers all of the services original Medicare does not, such as vision, hearing, dental and routine exams.
Once you’ve educated yourself on the different Medicare plans, the next step is enrollment. You’re allowed to sign up during the initial enrollment period beginning three months prior to turning 65 and up to three months after. If you miss the enrollment period, then you’ll have to wait for the open enrollment period which starts October 15 and ends December 7. During open enrollment, you can join, switch or drop a Medicare Advantage plan. Once changes are made during open enrollment, your coverage will take effect beginning January 1 of the following year.
It’s important to understand what Medicare is and the two ways in which you can get coverage. Choosing the right healthcare plan is critical since the aging process often involves needing additional health services. Make sure you understand the different variations of the Medicare plans and what they cover so you can choose the best plan for you.
Once you turn 65, you should try to enroll within the three months prior or the three month post your 65th birthday to avoid accumulating any penalty fees. Remember the open enrollment dates of October 15 through December 7 when you can re-evaluate your plan and make any necessary changes that can help improve your healthcare situation.
PharmD Live treats Medicare patients with two or more chronic diseases. Since medications are the cornerstone of chronic disease management, their potential for both help and harm is enormous. There’s an 82% risk of an Adverse Drug Event occurring when patients are placed on seven or more medications, and according to the FDA, Adverse Drug Reactions are the 4th leading cause of deaths in the United States. PharmD Live’s team of board-certified pharmacists partner with your physicians to deliver healthcare solutions that address your specific health conditions and help you properly manage your medications. They reduce the risk of Adverse Drug Events and make recommendations to your physician if you experience unpleasant side effects. Ask your doctor about PharmD Live today.
About PharmD Live
We are a telehealth company on a mission to save lives and improve patient health outcomes. We partner with healthcare entities to provide seamless, collaborative disease management and medication risk management solutions for patients suffering from two or more chronic diseases.
- Sign up for Medicare: How and When to enroll in Medicare. https://www.ehealthMedicare.com/. Accessed November 17, 2020.
- The Pros and Cons of Original Medicare, Medicare Advantage, Medical Supplement Insurance and Medicare Part D. https://www.Medicareadvantage.com/. Accessed November 17, 2020.
- What Medicare Covers. Medicare Website. https://www.Medicare.gov/what-Medicare-covers. Accessed November 17, 2020.