Explaining Medicare Services for Senior Citizens

Medicare Explained for Seniors

Medicare is a senior citizen service that provides medical insurance for those aged sixty-five and over. Many senior citizens are concerned about joining Medicare because it seems very overwhelming and confusing to them. It’s true that Medicare is not the simplest service to understand or predict. However, it does provide for medical services for those who may not have coverage with their employer, in the event the senior is still working or has returned to the work force following retirement. A program such as Medicare is also particularly beneficial to seniors because health tends to deteriorate as aging occurs, and more coverage may be needed.

Just like Social Security, Medicare is a senior citizen service that you pay into while you are working. For this reason, it makes sense to use something that you have already paid for. But that is only the start. Medicare is based on an HMO (Health Maintenance Organization) system, meaning that the government pays private medical practices to see patients that are covered by Medicare. However, a member of Medicare can still use medical services that are beyond what Medicare covers. He or she will just have to pay for it out of pocket.

There are also a number of different Medicare options and it’s important to understand them as well as your own needs to make sure that you select the best coverage for you. The most basic Medicare package is actually split into three parts, giving members the most options when it comes to meeting their needs.

The first package, Part A, covers hospital care only. The regulations covering Medicare Part A need to be understood prior to a hospital stay, so there aren’t any surprises.

The second is Part B, which covers medical health care, including services like doctor visits, x-ray and lab work. Some of these services have no deductible, while others do. Again, understanding coverage prevents disappointing surprises. Most Medicare recipients have supplemental Part B coverage because the Medicare share is limited.

Part D is prescription drug coverage.  There are many Prescription Drug programs available in the private sector; an Internet search of Medicare Prescription Drug Programs produces thousands of hits. In the Part D program the insured typically pays a monthly premium (or it may be included in Part B coverage) as well as a co-pay for medication prescribed by a physician. Most Part D programs have ‘tiered’ coverage, meaning generic medications have a lower co-pay while newer brand medications require a higher copay. In the regular Medicare program, the member is required to pay a small deductible before payment for covered services kicks in.

The basic Medicare program does not cover all the cost of medical care, and a supplemental health insurance policy is generally a good choice to cover some or all of what Medicare does not. Supplemental policies are available in the private sector for both Part A and Part B services.

Medicare Advantage Plans–Part C

Medicare Advantage Plans (Part C) offer even more coverage. These plans are fairly new and are a result of much reassessing and reorganizing by the government. Medicare Advantage is Medicare coverage that replaces the basic program and offers greater coverage, to the point that one may not need a supplemental private policy. Advantage plans feature additional coverage for hospital stays, a more comprehensive tiered prescription drug coverage, and generally lower deductible fees. Medicare Advantage is available throughout the country, and may be something readers will want to look into.

One important thing to keep in mind as you’re evaluating your options is that while there are ten standardized Medicare supplement insurance plans, Medicare Advantage plans can vary from company to company. So the benefits provided by a Medicare Advantage plan from one insurance company may be significantly different from a similarly priced plan from another.

As Medicare regulations and coverage change, SCJ will add articles that explain both changes and possible advantages or disadvantages. Stay tuned!