Does Medicare cover everything I need?
Medicare is the government’s health insurance for persons who meet specific criteria. To be eligible for coverage, you must be 65 years or older, disabled, or have severe renal disease. Original Medicare consists of Part A (hospital insurance) and Part B (medical services insurance). For prescription coverage, Part D Medicare drug plans are offered.
Medicare Part A covers many hospital related costs. Inpatient care in a hospital or skilled nursing facility are covered. Hospice services and home health services are also covered under Part A. If you or your spouse paid Medicare taxes for at least ten years, you are probably eligible for premium-free coverage. If you must purchase Part A coverage, you must also have Part B Medicare and pay premiums on both parts.
For the medical coverage, basic medical needs are paid for. This covers normal medical care, including visits with your physician and outpatient procedures. Certain preventative procedures are also covered, like mammograms. Most people have primary medical coverage through a private company and don’t pay premiums for the hospital coverage.
Medicare Advantage Plans, also called Part C, are also provided by a private company but must be approved to provide Medicare. Through this type, you are provided with access to both medical and hospital coverage, but you have to pay premiums with the company and for the medical coverage. Although these forms of insurance are available, whether directly through Medicare or through an approved company, you are not provided with prescription coverage. This is where Part D fits in.
If you need prescription coverage, it is important to understand that you must also have the hospital or the medical insurance-or both. If you have your hospital coverage through Medicare, you won’t need to have the medical coverage too. If, however, you have a private plan, in order to qualify for the prescription coverage you must have both the medical and the hospital coverage.
There are a few factors to consider when deciding whether or not you need Part D coverage. Are you already covered under a creditable prescription plan? These plans are offered from your employer, your spouse’s employer, or a union and are supposed to adhere to the same payment amounts as Medicare.
You must also consider the prescription lists for Part D Medicare drug plans and the costs of each plan. You need to compare current prescriptions you’re taking with the ones covered on the lists; include brand name and generic versions. Costs, like co-pays, should be compared as well.
