When navigating the inevitable aging process, staying updated and equipping ourselves with medical knowledge and information becomes increasingly important as our parents approach retirement.
Nowadays, various healthcare coverage and subsidy programs are available, aiding seniors and their families to take good care of themselves through necessary medical and wellness services.
Since 1965, Medicare has provided millions of Americans with affordable and comprehensive health plans, ensuring that all qualifiers receive equal medical attention in times of emergency. The government-funded program also assists many seniors in achieving a longer and healthier life with its nationwide network of healthcare providers.
Let’s explore the basics of Medicare services for seniors and some tips on signing up for the program.
A Brief & Comprehensive Guide to Help Your Parents Understand Medicare
What Is Medicare?
Medicare is a healthcare program launched in 1965 by the federal government to enhance older adults’ well-being, regardless of health status, income, and background, through paying for many aspects of healthcare and medical services.
Given the complexity and outrageous cost of healthcare in the United States, its primary mission is to provide seniors with better access to medical care and offer greater peace of mind when obtaining essential medical services.
A senior is eligible for Medicare under the following conditions:
- They are 65 and above.
- They are U.S. citizens or permanent residents living in the states for at least 5 consecutive years.
- They have contributed payroll taxes for at least 10 years or more.
Although the health plan is generally associated with senior citizens as soon as they turn 65, the health plan extends to individuals younger than 65 who:
- Have been diagnosed with end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS).
- Have collected pensions and payments from Railroad Retirement Board or Social Security Disability Insurance (SSDI) after a two-year waiting period.
How Medicare Works
Under the Centers for Medicare and Medicaid (CMS) administration, Medicare sets out to minimize the financial burden of medical expenses on seniors. In other words, it facilitates seniors to afford quality healthcare by subsidizing costs based on the chosen plan.
Like other types of health insurance, seniors must pay fixed monthly premiums to receive their benefits and coverage. Since the primary purpose of Medicare is to help seniors take better control of their health through a health plan aligning with their individual needs and budget, it consists of four components made widely accessible to meet each senior’s unique requirements.
Medicare Part A
Medicare Part A covers inpatient care, such as skilled nursing facility care, in-home care, critical access hospitals, hospice care, and some health visits. Part A is generally free for seniors who have contributed to the Medicare plan through their payroll taxes for at least 10 consecutive years. Part A is premium-free if a senior has contributed their Social Security benefits through payroll deductions in at least 10 working years.
Services covered by Medicare Part A include:
- Inpatient medical services: critical access hospitals, acute care hospitals, inpatient rehabilitation facilities, long-term care hospitals, and inpatient psychiatric facilities.
- Skilled nursing facility care: medical social services, medications, medical supplies and equipment, ambulance transportation, speech-language pathology services, and dietary counseling.
- Home health services
- Hospice benefits
Medicare Part B
In contrast to Part A, Medicare Part B aims at covering outpatient care and services uncovered by Part A, such as medically necessary outpatient care, physician visits, and preventive services (flu shots, vaccinations, health screenings, etc.).
Services covered by Medicare Part B include:
- Screenings: mammograms, colonoscopies, etc.
- Preventive care
- Ambulance services
- Mental health services: psychiatric evaluations, therapy, counseling,
- Annual wellness checkups and visits
- Durable medical equipment (DME)
Medicare Part C
Medicare Advantage is another name for Part C. The plan encompasses all kinds of services and benefits offered by Parts A, B, and D alongside extra services. It means that instead of purchasing Part A, B, and D separately, seniors can receive the same medical services and benefits offered by Part A & B under a single policy of Part C.
Medicare Part C provides medical services through networks of contracted doctors and physicians. It means seniors can opt for the best health network for their conditions and budgets. Unlike other health plans, Medicare Part C is marketed and sold through private insurance carriers approved by Medicare.
Some network health plans offered by Medicare Advantage are:
- Health Maintenance Organization (HMO)
- Private Fee-for-Service (PFFS)
- Preferred Provider Organization (PPO)
- Special Needs Plans (SNPs)
- Point-of-Service Plans
- Medical Savings Account (MSA)
Medicare Part D
The costs of medicine and prescription can be as draining as covering the expenses during your parents’ hospital admission. That’s why Medicare Part D was established to offer cost-effective drugs and prescriptions for all seniors. Enrolling in Part D is voluntary, and it helps to pay for a wide variety of medications, from generic brands to brand names specified for long-term treatment, home orders, home infusion, and retail. Much like Medicare Part C, only Medicare-authorized private insurance carriers can sell the stand-alone plan based on each person’s preferences. Most people purchase Part D to complement their Original Medicare (Part A & B).
Understanding Medicare Key Terms
Familiarizing yourself with Medicare means having a good grasp of common terminologies you might run into while helping your parents understand the basics of Medicare. Some key terms of Medicare insurance are as follows:
- Deductible: The insured is responsible for paying a fixed amount out of their pocket before their plan starts to kick in. Let’s say your deductible is $1,500. The plan will cover after you max out $1,500 of covered services yourself.
- Premium: Premium is a fixed payment the insured must pay each month. While Medicare Part A is accessible for people in the workforce for at least 10 years, Medicare Parts B, D, and Medicare Advantage plans all require monthly premiums. If the insured has no work history, they may be charged premiums for Part A.
- Copayments, or coinsurance: Coinsurance is a fixed percentage split for the insured and their insurance provider based on the kind of tier or level of coverage opted for. The most common copayment percentage is 80/20, with 80% billed to the insurance provider, whereas the insured is responsible for the remaining 20%.
How Much Does Medicare Cost?
Check the table below for the overall cost breakdowns of each Medicare component as of 2023:
|Part of Medicare||Monthly Cost|
|Medicare Part A (inpatient care)||Free|
|Medicare Part B (outpatient care)||$164.90|
|Medicare Part C (Medicare Advantage)||$18 on average|
|Medicare Part D (prescription coverage)||$31.50 on average|
Medicare Enrollment Periods: Tips on How To Enroll in Medicare
As discussed above, all seniors automatically qualify for Medicare when they turn 65. They are given a 7-month window, deemed the initial enrollment period, to prepare the necessary paperwork. The initial enrollment lasts seven months, ranging from 3 months before the 65th birthday, throughout the birthday month, to 3 months after the 65th birthday.
The best thing about the initial enrollment period is that even if your parents miss the timing, they can still enroll in other enrollment periods without fearing penalties for the delay. Suppose they miss the first chance of enrollment. In that case, they can sign up in the general enrollment period, which starts between January 1 and March 31 each year.
One of the most crucial things to remember when helping your parents register for Medicare health plans is to consider their health conditions and determine the kinds of medical services that might be favorable for achieving healthy aging and managing their current health status.
Visit the Medicare.gov government website and enter the ZIP code to check for Medicare plans available in your parents’ residency. Contact professional brokers or community advisors for assistance if you need more enrollment information or enroll under particular circumstances.
Check the following link for registration forms and how to enroll in Medicare under special enrollment periods.
If you have questions about Medicare services for seniors or any topics discussed here, connect with us and learn more.
At 12 Oaks, our team of caring professionals is dedicated to keeping residents safe, engaged, and connected to their families and friends while leading fulfilling lives. 12 Oaks senior living communities are an ideal place to enjoy the encore season of life.
For questions or to schedule a personalized tour, don’t hesitate to contact us.
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