Understanding Medicare -  Need-to-know Information for Navigating Your Federal Healthcare Options

The federal health insurance program Medicare is complicated but not impossible to understand. The program does have numerous parts and add-ons, and the details of your selected policy can change from year to year, as can the premium.

However, Medicare itself offers comprehensive information at medicare.gov; clear, concise publications you can download or have mailed to you; toll-free numbers for your questions; and Medicare counselors in a town near you who can walk you through the entire process in-person or by phone. But before you make contact, here’s a quick overview of Medicare – what it is, its parts and how those parts work together or not – so you know what specific questions to ask.

 

The Basics

Medicare is a federal health insurance program for people who are 65 years old or older. Some people with certain disabilities or diseases qualify for Medicare before they reach 65 years of age. 

 

Medicare Parts

Medicare is available in four parts – A, B, C, and D – each with its own level of services. Additionally there is Medicare Supplement Insurance, or Medigap, which is not Medicare but a private policy that works with your Medicare policy to supplement your healthcare costs.

  • Medicare Part A, in general, covers hospitalization, skilled nursing facility care, hospice care and some home-health services. This part is offered through the federal government with no premiums for most American citizens if they or their spouses paid Medicare taxes for a certain amount of time while working.

  • Medicare Part B pays for medically necessary services, physician’s services, outpatient care, medical supplies, durable medical equipment, ambulance services and some preventative screenings and services. This part is offered through the federal government and is combined with Part A. Part B does have premiums.

  • Medicare Part C is also known as Medicare Advantage Plans. These plans are offered through private insurance companies and premiums are charged. These companies contract with Medicare to provide Medicare A and B benefits plus benefits and services not covered under A and B. They may offer extra coverage, like vision, hearing, dental or health and wellness programs.Also, many Part C plans offer prescription drug coverage (so if you have your Medicare through Part C, you won’t need Medicare Part D). With Medicare Part C, you typically are part of a Health Maintenance Organization (HMO), a Preferred Provider Organization (PPO), a private fee-for-service plan, a special needs plan, or a Medicare Medical Savings Account (MSA)Plan.

  • Medicare Part D covers prescription drugs. It is an add-onto Parts A and B. As with Part C, Part D is offered through private companies approved by Medicare and there is a premium. Be aware that there is a penalty for late enrollment.

 

 

Supplemental Insurance

Medicare Supplement Insurance, or Medigap policies, are sold by private insurance companies and are meant to supplement Original Medicare, also known as Parts A and B.Medigap policies help pay some of the health care costs that Medicare doesn't cover, like copayments, coinsurance and deductibles. Some Medigap policies also cover services that Original Medicare doesn't cover, like medical care when you travel outside of the United States.

Newer supplemental policies do not include prescription drug coverage. To obtain such coverage, you need to sign up for Medicare Part D or a supplemental plan with drug coverage. Note that if you have Medicare Advantage Plan (Part C), it is illegal for a company to sell you a Medigap policy. You will need to choose whether Medicare Advantage Plan (Part C) or a supplemental policy best suits your needs. 

The Medicare parts you choose are highly specific to your unique situation. One starting point for figuring out what type of Medicare coverage is right for you is the questionnaire at medicare.gov/medicarecoverageoptions. Our Medicare Help section also has resources that can help you make informed choices so you can get the healthcare coverage that best fits your individual needs.

 

 

SUPPLEMENTAL MEDIGAP POLICIES IN N.C.

There are 11 types of supplemental policies offered in North Carolina – A, B, C, D, F, F Prime, G, K, L , M and N. To find out what is covered by each policy type, visit the N.C. Dept. of Insurance’s Medicare Supplement Premium Comparison Database at ncdoi.com/medisupp.

 

 

MEDICARE HELP

medicare.gov

This website offers thorough explanations about the Medicare program, updates on changes and answers to frequently asked questions. It also offers Medicare & You for download to your computer, as an e-book reader or as an audio podcast. You also can request that information be mailed to you on an audio CD orin print form, which is also available in large print and braille formats.Within this reference is everything you need to know about Medicare and supplemental policies, along with easy-to-read charts that allow you to compare and contrast parts, policies and benefits.

 

800-MEDICARE

Call this toll-free helpline to speak with someone trained to help you with any Medicare question or issue.

 

Seniors’ Health Insurance Information Program (SHIIP)

ncdoi.com/shiip

855-408-1212 (toll-free)

Each county in North Carolina has its own SHIIP counselors specially trained to help you with your Medicare questions. You may speak with them by phone or set an appointment to meet in person. Here is contact information for some of theSHIIP programs in our area:

 

In Buncombe County

828-277-8288 (ask for SHIIP help)

Council on Aging of Buncombe County

46 Sheffield Cir., Asheville

 

In Haywood County

828-356-2800 (ask for SHIIP help)

Mountain Projects, Inc./Senior Resource Center

81 Elmwood Way, Waynseville

 

In Henderson County

828-277-8288 (ask for SHIIP help)

Blue Ridge Health

709 N. Justice St., Hendersonville

 

828-692-4203

Council on Aging for Henderson County

105 King Creek Blvd., Hendersonville

 

In Madison County

828-398-7700 (ask for SHIIP help)

Asheville-Buncombe Technical Community College

4646 US 25-70, Marshall

 

In Mitchell County

828-688-4811 (ask for SHIIP help)

Mitchell County Cooperative Extension

10 South Mitchell Avenue, Bakersville

 

In Polk County

828-749-9245 (ask for SHIIP help)

Saluda Senior Center

64 Greenville St, Saluda

 

828-894-0001

The Meeting Place

75 Carmel Lane, Columbus

 

In Rutherford County

828-287-6409 (ask for SHIIP help)

Rutherford County Senior Center

193 Callahan Koon Rd. # 132, Spindale

 

In Transylvania County

828-884-3109 (ask for SHIIP help)

Transylvania County Cooperative Extension

106 E. Morgan St., Brevard

 

In Yancey County

828-682-6011 (ask for SHIIP help)

Yancey County Committee on Aging

503 Medical Campus Drive, Burnsville

 

MEDICARE HELP

medicare.gov

This website offers thorough explanations about the Medicare program, updates on changes and answers to frequently asked questions. It also offers Medicare & You for download to your computer, as an e-book reader or as an audio podcast. You also can request that information be mailed to you on an audio CD or in print form, which is also available in large print and braille formats.Within this reference is everything you need to know about Medicare and supplemental policies, along with easy-to-read charts that allow you to compare and contrast parts, policies and benefits.

 

1-800-MEDICARE

Call this toll-free helpline to speak with someone trained to help you with any Medicare question or issue.

The federal health insurance program Medicare is complicated but not impossible to understand. The program does have numerous parts and add-ons, and the details of your selected policy can change from year to as can the premium. 

Medicare offers comprehensive information at Medicare.gov; clear, concise publications you can download or have mailed to you; toll-free numbers for your questions; and Medicare counselors in a town near you who can walk you through the entire process in-person or by phone. But before you make contact, her's a quick overview of Medicare - what it is, its parts and how those parts work together or not - so you know what specific questions to ask. 

The Basics: 

Medicare is