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A Layman's Guide to Medicare A, B, and C

Wed Aug 26, 2015 15:59:27PM | Categories: Medicare & Medicare Part B
Doctor consulting with a patient in the hospitalBy: Public Domain
Whether you are preparing to sign up for Medicare or if you are already enrolled and are searching for ways to get the most out of your benefits, there are a few simple things you can do that will help you get the most out of your Medicare benefits. Choosing which option is best for you can potentially save you money in the long run, but that does depend on your specific needs and a variety of other factors, so it's important to do some research before making your final decision.

For those of you who haven't signed up for Medicare yet then you can do so during a seven month period before and after you turn 65. You can begin the sign up process three months before your birthday, the month of your birthday, and three months after your birthday. If you sign up before your birthday then your benefits will begin the day you turn 65. However, if you do miss this window the seven month window then you will have to wait for the Medicare open-enrollment period, which lasts from January 1 through March 31 of each year.

After you complete the sign up process is when you will need to decide if you wish to enroll in traditional Medicare (Parts A & B) or a Medicare Advantage Plan (Part C). You also have the option of enrolling in prescription drug coverage, or Medicare Part D. Which one is best for you is something that you and your loved ones must decide for yourselves, but I will explain the differences between the two below.

Traditional Medicare (Parts A & B)

Traditional Medicare is when your Medical benefits are paid for directly by the government. Medicare Part A is hospital insurance (hospitals, home health care, etc.) and Medicare B is medical insurance that is not covered inside of a hospital (doctors visits, ambulance services, mental health services, etc.).

If you choose traditional Medicare then you would pay the standard rates for any of the services you receive, regardless of where you live. You are eligible to go to any doctor, hospital or other provider that accepts Medicare patients throughout the United States.

There is no monthly premium for Part A, but there is a monthly premium for Part B, which is currently $104.90 each month. If you do have a hospital visit and use your Part A benefits then you will be required to pay a deductible, which is currently $1,260. Your first 60 days in a hospital or nursing home are covered, but then you will begin to be required to pay a coinsurance beginning on day 61. That currently stands at $315 per day through day 90. After you reach 90 days then you will have to use your Lifetime Reserve Days, which will cost $630 per day, but every beneficiary is limited to a total of 60 reserve days in their lifetime.

Medicare Advantage (Part C)

Medicare Advantage plans are private health insurance plans that are offered by health insurance companies. These companies must offer everything that is covered by Medicare Parts A and B, with the exemption of hospice services, and typically offer a variety of services that are not covered under 'traditional' Medicare.

A health insurance company must be pre-approved by the Centers for Medicare and Medicaid Services, which then pays these private companies a fixed monthly amount per individual enrolled. The plans come in all shapes and sizes and it would take an entirely different posting to explain all of the various types of plans, but the gist of it is that a private insurance company would be administered through a private company and would be subject to the rules and guidelines of that plan.


Which one is better for you?

That is a question that you must decide for yourself. There are pros and cons to each and much of it is largely dependent on your financial situation. Regardless of what you decide, you will still need to enroll in Traditional Medicare" before you can sign up for Medicare Advantage. And if you don't initially sign up for Medicare Advantage then you will have to wait for the special enrollment period, which is between October 15th and December 7th of each year.
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how do I signup for Medicare A & B ?
Anonymous
308 days ago
Edit | Replies (0)
Call your local Social Security Office and make an appointment. You can just walk-in but it can be a really ling wait. Here is the national number they are easier to reach and can make appointments st your lical office. 1(800)-772-2213.