Medicare Made Simple: Your Guide to Understanding Healthcare

Navigating the complexity of Medicare can be a lot. In this blog, we will break down complex Medicare concepts into clear and actionable information for our patients and the surrounding Barbour County communities so you can make informative and actionable decisions.

To start, what is Medicare? Medicare is one of the federal and state health insurance programs available in the United States. It offers basic coverage to help pay for things like doctor visits, hospital stays, and surgeries. The program is funded in part by Social Security and Medicare taxes citizens pay on their income, in part through premiums that people with Medicare pay, and in part by the federal budget.

Medicare consists of four different “Parts” that cover specific healthcare services. To put it simply:

• Part A provides inpatient/hospital coverage.
• Part B provides outpatient/medical coverage.
• Part C offers an alternate way to receive your Medicare benefits known as Medicare Advantage.
• Part D provides prescription drug coverage.

When eligible, patients can enroll in Medicare Parts A and B, also known as Original Medicare which covers the essentials. Part A covers things like inpatient hospital stays, home health care, and some skilled nursing facility care. Typically, most people don’t pay for A if they have paid Medicare taxes for a certain amount of time while working. However, if you don’t qualify for a premium-free Part A, it can be purchased for a monthly premium. With Part B, you are responsible for a monthly premium and Part B covers things like doctor visits, outpatient services, X-rays and lab tests, and preventative screenings.

Part C, also known as Medicare Advantage plans are offered through private health insurance companies. When you join a Medicare Advantage plan, you still have Medicare which can be a common misconception. The difference is the plan covers and pays for your services instead of Original Medicare.

While some prescriptions are covered as part of Part A, Medicare Part D helps to cover the cost of prescription drugs. It can help lower drug costs now and help protect against higher costs in the future.

The Medicare program is for people 65 and older, people under 65 with certain disabilities and people with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS). According to the Centers for Medicare & Medicaid Services, a person who is entitled to monthly Social Security or Railroad Retirement Board (RRB) benefits on the basis of disability is automatically entitled to Part A after receiving disability benefits for 24 months. For more information about special rules and Medicare based on disability, visit cms.gov.

Another common misconception to note is that patients are automatically enrolled in Medicare when they turn 65. While this may be the case for some, you should always contact Medicare to be sure. People may only be automatically enrolled when they turn 65 if they are already drawing social security benefits.

Other common questions include:

• Are all of my medical costs covered by Medicare? While Parts A and B provide great coverage, it rarely provides everything a patient needs. You will want to factor in costs for prescription drugs, dental, vision, hearing and long-term care.
• Is Medicare free? To put it simply, no. However, there’s a good chance patients can receive at least a portion of their coverage at no charge, specifically Part A.
• Is Medicare the same thing as Medicaid? No, they are two separate programs. Medicare is a government-sponsored health insurance that is available to all Americans ages 65 and older or those with certain disabilities. Medicaid is a state and federal program that assists families and individuals with low and limited incomes. However, the two do work together when a patient has been deemed eligible for both.

The last area we will cover is Medicare wellness visits. The annual wellness visit is a yearly appointment with your primary care provider (PCP) to create or update a personalized prevention plan. The prevention plan may help prevent illness based on current health and risk factors. During your first wellness visit, in addition to developing your plan, your PCP may also check your height, weight, blood pressure and other routine measurements, give you a health risk assessment, learn about our medical and family history, review your level of safety, as well as list your current providers and current medications. Wellness visits after your first may consist of updating your preventative plan, checking your weight and blood pressure and screening for cognitive issues if needed.

To enroll in Medicare, contact the Social Security Administration or your local Social Security office. For more information regarding Medicare, visit Medicare.gov or contact your local Barbour County Health Association office. Both Quick Care locations are open with extended evening hours available. Visit the Myers Clinic location at 116 McClellan Road, Philippi on Mondays through Saturdays from 7 a.m. to 7 p.m. or the Belington location at 95 S. Crim Avenue, Belington on Mondays through Fridays from 7 a.m. to 7 p.m.