Page 3 - Senior Times South Central Michigan - October 2017 - 24-10
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Senior Times - October 2017 Page 3
THE ABCS OF MEDICARE By: Glin Winsor, Store Manager, Walgreens
Medicare is considered one of the most important government sponsored benefits in the US. There are currently more than 57 million people covered by Medicare, 70% of them are enrolled in Part D plans. Medicare is different than Medicaid.
First it is important to know that Medicare has four parts:
• Medicare Part A – Hospital coverage
• Medicare Part B – Medical
(Physician) Coverage
• Medicare Part C – Medicare advantage Plans Like HMO
• Medicare Part D – Prescription drug coverage
Medicare is for people age 65 and over; people with certain disabilities under age 65; and people with end-stage renal disease – permanent kidney failure requiring dialysis or a kidney transplant.
Medicare is for US citizens and legal residents who have paid Medicare payroll taxes for at least 10 years or who have met other specific guidelines. Enrollment is open three months before, during, and three months after your 65 birthday month. Note: if you do not sign up during this time, you may experience
a penalty and/or higher premium costs.
Medicare part A is also known as hospital insurance, Medicare Part A covers all or part of inpatient care, hospital care, skilled nursing facility care, nursing home care (non-custodial), and home health services.
Medicare Part B covers things like physician fees, outpatient hospital services, ambulance services, durable medical equipment (DME), mental health services, second opinions, and some drugs not covered by Part D.
Medicare Part C is an alternative to “original Medicare” sometimes also referred to as a Medicare Advantage Plan or MA Plan. It is offered by private insurance companies
approved by Medicare. Most MA Plans include extra benefits such as vision, dental, etc. Most include prescription drug coverage. With an MA Plan, you’ll get your Medicare Part A (Hospital Insurance), form the Medicare advantage plan and not the traditional “original Medicare.”
Medicare part D is for prescription drugs, not over the counter (OTC) drugs. Each Medicare Prescription Drug Plan has its own list of covered drugs (called a formulary). To find out if your prescriptions are covered ask your pharmacist or check online at https://www.medicare.gov-a-plan/questions/ home.aspx.
Medicare Part D is an insurance plan provided by private companies that contract with the Centers for Medicare and Medicaid services. You have a choice of Part D plans
in your area. Part D plans have different premiums and covered drugs. You can choose a Part D plan that includes just drug coverage or choose a Medicare Advantage Plan that includes Medicare Parts A, B, and D.
Medicare Part D helps you afford the medication you need to stay well. Even if you don’t take many prescriptions today, the coverage will be there when you need it. If you don’t enroll when first eligible (usually when you turn 65) you will likely pay a late-enrollment penalty.
How do I pay for Medicare Part D coverage?
• Premium
• Yearly Deductible
• Copayments or coinsurance
• Costs in the coverage gap
• Availability of extra help
• Costs if you pay a late enrollment penalty When should I enroll in Medicare
Part D? Annual election period is October 15 through December 7 each year. Late
enrollment will result in a penalty and higher premiums. For information on special enrollment periods, visit Medicare.gov.
How do I choose a Medicare Part D plan?
Select a Part D plan available in your area that covers the medications you are taking and has a payment structure that best fits your needs.
There are many plan comparison tools for Medicare Part D available on the internet. The government offers a free comparison tool at https://www.medicare.gov.
What is the “doughnut hole” in Medicare Part D? The coverage gap, also known as the donut hole, is a temporary limit on what the drug plan will cover for drugs. The gap begins after you and your drug plan spend a certain amount for covered drugs. In 2017, the gap begins when you reach $ 3,700 in prescription drug costs and ends once your out of pocket costs reach $ 4,950. While in the gap, you will receive a discount on the cost of your drugs:
• 60% on brand-name drugs • 49 % on generic drugs.
Not all plans have a coverage gap and the amounts can vary. Those who receive Extra Help with paying Part D costs won’t enter the coverage gap.
Insurance companies offer Medicare supplement insurance, also known as MedGap. You must have both Medicare Part A and B to qualify for a supplemental policy.
You might also have a retiree policy that pays what Medicare doesn’t cover. Medicare typically pays first. Ask your employer for additional information.
Medicare and Walgreens
Walgreens accepts Medicare Part B, Part C and Part D plans for immunizations, healthcare clinic visits, medications, medical supplies
For more information contact Medicare at 800-MEDICARE or www.medicare.gov.
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