Loading...
Blog

Blog

Medicare 101: Unraveling the mystery

Like all government programs, Medicare has many rules and regulations and navigating it can be very difficult and possibly frustrating. Intermountain Healthcare decided to put together this guide to help you get the coverage you need.

Stack of Medicare literature with stethoscope

What are Parts A and B?

Simply put, Part A is hospital insurance, and Part B is medical insurance.

  • Part A covers hospital stays and inpatient care, including skilled nursing services, surgeries, X-rays, and lab tests. Part A has no premiums, but there is a deductible: For an overnight stay in a hospital, it will cost $1,408 per benefit period (up to 60 days). And if you go beyond that, there’s an additional charge of $341 per day for up to 90 days. From there, the cost is $704 per lifetime reserve day. And there’s no out-of-pocket limit.
  • Part B covers doctor visits and outpatient care, including annual wellness visits and preventive services, clinical laboratory services, diagnostic tests, physical therapy, occupational therapy, speech therapy, diabetes screenings and certain supplies, mental health services, durable medical equipment, and ambulance services. For Part B, there is a $144.60 per month premium, and you must meet an annual deductible of $198. After you meet your deductible, you’ll pay 20% of the cost for all of your medical services. Like Part A, there’s no out-of-pocket limit.
  • Part D covers prescription medications (more about that later).

What’s NOT covered

Original Medicare (Parts A and B) does not cover:

  • The total cost of your care — you have out-of-pocket costs with no limit
  • Prescription drugs
  • Routine dental, vision, or hearing care
  • Eyeglasses, contacts, or hearing aids
  • Long-term or custodial care
  • Excess charges for services by doctors who don’t accept Medicare
  • Care received outside the U.S., except for certain circumstances

Covering the gap

Medicare doesn’t cover everything, which is why there are two options you can choose to cover the remaining expenses:

  • Add a Medicare Supplement plan and a Medicare Part D plan After you meet your deductible, Medicare covers 80% of the costs for hospital medical services — and your supplement plan covers the remaining 20%. Keep in mind, it is mandatory to have a prescription drug plan so you will have to add a standalone Part D plan.
  • Medicare Advantage plan (also known as Part C)

This combines Part A and Part B all under one plan and includes a Part D prescription drug plan, plus it may offer additional benefits not provided by Original Medicare. There are various plans offered by private insurance companies.

Medicare Advantage takes up where Original Medicare leaves off

In addition to covering Original Medicare Parts A, B, and D, Medicare Advantage plans may offer additional benefits to give you comprehensive healthcare coverage:

  • Dental exams, cleanings, and X-rays
  • Eye exams, eyeglasses, and corrective lenses
  • Hearing tests and hearing aids
  • Wellness programs and fitness memberships

Healthcare costs are going nowhere but up, and Medicare Advantage plans protect you with an annual out-of-pocket maximum. Unlike Original Medicare, with a Medicare Advantage plan, your insurance company gives you a certain amount throughout the year for hospital and medical services, and when that amount is met, the plan is covered at a hundred percent.

Like conventional healthcare insurance, Medicare Advantage offers you a choice of several types of plans, including Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), Point of Service (POS), and Special Needs Plans (SNP).

What about prescription drugs?

Medicare offers you two ways to get your prescriptions covered:

  • Add a standalone Part D plan to Original Medicare
  • Choose a Medicare Advantage plan that includes prescription drug coverage

Medicare Supplement Insurance: Medigap

Like Medicare Advantage, Medigap insurance helps you cover costs not paid by Original Medicare. You can choose from 10 Medigap plans standardized by the federal government, as well as plans that are offered by private insurance companies in Nevada. However, Medigap insurance cannot be used together with Medicare Advantage — so you need to decide which best plan suits your needs.

Getting started: When and how to enroll

If you’re turning 65, you have three months before and three months after your birthday to enroll in Medicare. If you’re receiving Social Security or Railroad Retirement Board benefits or if you’ve been receiving disability benefits for 24 months, you will be enrolled in Parts A and B.

If you’re working past 65, you may enroll once you retire and receive coverage under Medicare Parts A and B. You may also choose a Part C or Part D plan, and remember to enroll in Part D early to avoid penalties.

You can change your coverage during the Annual Enrollment Period, which runs October 15 through December 7, and your new plan will begin January 1.

If you want to change your Medicare Advantage plan, during the Open Enrollment Period you can switch to a different plan or to Original Medicare between January 1 through March 31.

Need more help?

  • Visit Medicare.gov
  • Call 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048, 24 hours a day, 7 days a week
  • Call State Health Insurance Assistance Program (SHIP) or visit shiptacenter.org
  • Contact your local Social Security or state Medicaid office

What Intermountain Healthcare offers people on Medicare

Intermountain Healthcare has a unique network of myGeneration Senior Clinics designed specifically for Medicare Advantage members. These 30+ locations offer access to a dedicated referral team, onsite care managers and navigators, and onsite labs are available at most locations to cover all your healthcare needs. In addition, we offer 24/7 access to virtual care.

Our goal is to provide you with a VIP-style level of care. Patients get twice the average appointment (up to 30 minutes), so you’ll have more time with your care team to discuss your needs and get answers.

Intermountain Healthcare is staffed by nearly 300 primary care providers at more than 100 primary care locations. We have a network over 1,500 specialists, 25 urgent care and walk-in locations, and we’re affiliated and partnered with 20 hospitals in the valley.

To learn more about Medicare Advantage plans and myGeneration Senior Clinics, call us at 702-852-9000.

What’s Happening at Intermountain Healthcare

Part of being well is being heard.