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By Amy Farmer, Admission Director
Heartland of Greenville
For those who are navigating the Medicare system for the first time or
trying to better understand their options, below you will find a brief
overview of the ABCDs of Medicare.
You have two options for coverage through Medicare (see chart):
Individuals eligible for Medicare must choose, on a yearly basis during
the Annual Enrollment Period, to be covered by (Option 1) Medicare
Parts A, B and D OR (Option 2) to be covered by a Part C plan, which
typically includes a prescription drug plan.
Let’s review each part individually.
Medicare Part A is commonly referred to as hospital insurance or
inpatient coverage. It provides coverage, subject to deductibles
and co-payments, for inpatient hospital stays, skilled nursing
facilities, home health care and hospice care. Most individuals
do not pay a premium for Part A.
Medicare Part B covers physician and provider visits, outpatient
services, preventive wellness exams and durable medical equipment, also
subject to a deductible and co-payments. There is a monthly
premium for Part B coverage. For new Medicare recipients, the
Part B premium is $115.40 in 2011. It is important to note that
individuals with higher incomes may pay a higher premium for Part B,
and that delaying enrollment in Part B can result in
penalties.
Medicare Part C is often referred to as Medicare Advantage or Medicare
Choice. Medicare has contracted with private insurance companies
like Anthem and Humana, among others, to offer coverage that replaces
Parts A and B. Part B premiums must still be paid and sometimes
there is an additional premium for Part C plans. Some plans offer
additional benefits, like dental and vision, that are not included in
original Medicare. Most Part C plans offered in our area include
Part D coverage as well.
Medicare Part D is prescription drug coverage. There are
approximately 30 Part D plans currently available to Darke County
residents with a wide range of premiums, deductibles and
formularies. There are penalties imposed on individuals who do
not sign up for Part D plans when they are eligible to do so.
Secondary insurance is optional for individuals who have traditional
Medicare. It can include group health insurance for those who
have coverage from a current or past employer, or it may include
supplements to Medicare, purchased through private insurance companies,
that vary in premiums and coverage benefits. For individuals who
meet income and asset eligibility guidelines, Medicaid can also serve
as a secondary insurance to original Medicare.
Help is available to individuals interested in exploring their options
and better understanding their coverage through a free program called
OSHIIP (Ohio Senior Health Insurance Information Program). As a
Certified Medicare Counselor and the Darke County Coordinator for
OSHIIP, I am available to answer questions, run drug plan comparisons
and provide free assistance with Medicare-related issues. You can
call me locally at Heartland of Greenville at 548-3141 or call the
OSHIIP state helpline at 1-800-686-1578. I can also be reached
via email at 3241admiss@hcr-manorcare.com.
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