Medicare is a federal health insurance program that provides health insurance coverage for members, called beneficiaries. Medicare applies to beneficiaries who are 65 or older and are citizens or permanent residents of the United States, certain younger people with disabilities or anyone who has end stage renal disease.
Medicare beneficiaries may receive:
1. Medicare Part A - Hospital coverage that pays for hospital services, skilled nursing facilities, home health and hospice care. There is no cost to most beneficiaries. It is based on years in the work force.
2. Medicare Part B - Medical, professional or traditional coverage as it pays for doctor’s services, outpatient therapy, durable medical equipment, supplies and other needed services. Monthly premium payment is required.
3. Medicare Part C - Part of Medicare Part B. It is not really a separate coverage rather it allows for beneficiaries to select a managed care plan instead of a traditional 80/20 plan.
4. Medicare Part D Prescription Drug - This provides coverage for prescription drugs. This coverage is optional and requires payment of an additional premium.
Once you are approaching age 65, you will have a 7 month enrollment period in which to enroll for Medicare coverage. You have up to 3 months prior to the month of your birth, the month of your birth, up until 3 months after in which to enroll. If you miss this period, you will have to wait until the next scheduled open enrollment period.
Disabled persons are eligible to enroll for Medicare once they have been on SSI for 24 months.
After enrollment is completed, the beneficiary will receive a Red, White and Blue ID card. The beneficiary’s ID number is their 9-digit social security number, plus a one or two-digit suffix (added to back of the ID number, ex. 123456789A). A description of some of these suffixes is described below:
1. A WAGE EARNER
2. D AGED WIDOW
3. B AGED WIFE
4. D4 REMARRIED WIDOW
5. B1 HUSBAND
6. E MOTHER (WIDOW)
7. C1 CHILDREN
8. F1 FATHER
9. F2 MOTHER
Note: In keeping with the HIPAA requirement that all patient's PHI -protected health information must be kept secure, the Social Security number listed on all Medicare ID cards must be replaced with encrypted number before 2019.
At the time of enrollment, the enrollee must select either a traditional Medicare plan, which is a 80/20 plan or they can select a Medicare managed care plan with a wide range of coverage's and benefits.
Because of these two different paths, we have a tendency to separate Medicare into those categories - Traditional Medicare and Medicare Managed Care. The benefits, processes, rules and procedures differ greatly between the two.
Medicare Managed Care vs. Medicare Traditional
Medicare does not pay for: