The ABCs (and D) of Medicare

As Medicare’s open enrollment arrives, here’s an overview of the basics— especially geared for those newly eligible for Medicare

By Angelo Gentile

Get ready for the onslaught.

If you’re 65 or older, you can expect your mailbox to be jammed over the next several weeks with multiple flyers, brochures, postcards and more that provide tons of information about Medicare and its coverage options. And let’s not even mention the barrage of TV commercials.

That’s because Medicare’s annual open enrollment is Oct. 15 through Dec. 7. With open enrollment in mind, an overview of Medicare options to help sort things out makes sense—especially if you are signing up for the first time. Consider it the ABCs (and D) of Medicare.

PARTS A AND B: ORIGINAL MEDICARE

A quick way to remember these two: Part A is in-patient; Part B is outpatient.

Part A covers basic hospital stays and hospital care. Part A is required. That is, everyone who is 65 is required to sign up for Part A, given that Medicare is a health insurance program funded by the federal government (no premium payment for Part A is required from the individual).

Part B covers outpatient services such as doctor visits (primary care and/or specialists), lab visits, etc. Some people can delay signing up for Part B, for example, if they are still working and are covered by their employer.

The standard Part B monthly premium amount in 2021 was $148.50 (or higher depending on your income), according to Medicare.gov.

However, Original Medicare Parts A and B don’t cover everything. Hence, other programs exist within the Medicare landscape, such as Advantage Plans and supplement plans, to help fill in the gaps.

PART C: MEDICARE ADVANTAGE PLANS

Part C is, in a sense, a bundling of Parts A, B and D. Medicare Advantage Plans combine the coverage you get from Original Medicare (A and B) with additional benefits, such as routine vision coverage, hearing coverage, gym memberships in some cases, some over-the-counter (OTC) benefits, and prescription drug coverage.

According to Medicareinteractive.org, Medicare Part C is not a separate benefit. Part C is the part of Medicare law that allows private health insurance companies to provide Medicare benefits.

These Medicare private health plans, such as Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs),

contract with the federal government and are known as Medicare Advantage Plans. If you want, you can choose to get your Medicare coverage through a Medicare Advantage Plan instead of through Original Medicare. Many different kinds of Medicare Advantage Plans are available. You will pay a monthly premium for this coverage, in addition to your Part B premium.

“Over the years, the types of and the levels of benefits (available under Advantage Plans) have become more dynamic and more robust,” said Bernadette Harris, owner of Sierra Vista-based Sierra Medicare Solutions, which serves Cochise and Pima Counties. “Each carrier will have additional benefits, which may include vision, hearing, OTC benefits, telehealth options and more.”

Most, but not all, Advantage Plans include prescription drug coverage. Which leads us, next, to Part D.

PART D: PRESCRIPTION DRUG COVERAGE

The prescription drug benefit, Part D, is the part of Medicare that covers most outpatient prescription drugs. Part D is offered through private companies either as a stand-alone plan, for those enrolled in Original Medicare, or as a set of benefits included with your Medicare Advantage Plan.

SUPPLEMENT PLANS

Beyond the Medicare alphabet just listed, if you don’t opt for an Advantage Plan, you can choose a supplement plan, which helps pay some out-of-pocket costs that aren’t covered by Original Medicare Parts A and B—hence the term “supplement.”

However, these supplement plans do not include prescription drug coverage. Those who opt for supplement plans then also choose a separate prescription drug plan under Part D (see section on Part D). Monthly premiums for supplement plans vary.

“Supplements are designed to work in conjunction with Original Medicare,” said Jenifer Paterson, CEO of Tucson-based Senior Solutions USA, which serves Southern Arizona, including Sierra Vista and Cochise County. “Supplements pick up your cost shares that aren’t covered by Original Medicare.”

Ultimately, as mentioned, Original Medicare doesn’t cover everything. Accordingly, individuals choose either supplement plans or Advantage Plans.

Essentially, beyond Original Medicare, “individuals have two options,” Patterson explained. “You can choose an Advantage Plan (under Part C), or you can go with a supplement plan and then a Part D choice for prescription drugs.”

If this all sounds like a lot to sort out, it is. Therefore, it makes sense for those signing up for Medicare for the first time, as well as those reviewing their current Medicare plan, to consult with licensed Medicare sales agents and brokers (see related story on using Medicare brokers). As Patterson of Senior Solutions USA pointed out, they can help you tailor a plan that meets your individual medical and financial needs.

Get local help with your Medicare questions.

I’m ANA GEORGINA SANDERS, a licensed sales agent in Nogales Arizona. When it comes to Medicare, it’s important to consider all of your options. What works well for your neighbor may not be the best fit for you. I know the ins and outs of Medicare, and I’m ready to answer your questions and help you find a plan that fits your needs. Take advantage of my knowledge and experience to:

I look forward to helping you explore your Medicare options so you can enroll in a plan with confidence.

• Take the confusion out of Medicare • Get help comparing plans • Receive one-on-one service • Make enrolling in a plan easier

It’s time to take advantage.

ANA GEORGINA SANDERS

Licensed Sales Agent 520-223-3601, TTY 711 agsandersinsurance@gmail.com UHCMedicareSolutions.com

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