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Medicare offers medical benefits for seniors and disabled individuals. Coverage under this plan is confusing to many, prompting the following simplified explanation. The premium for this coverage is automatically deducted from your monthly social security benefit. Using your red, white, and blue Medicare card, you may go to any participating hospital, facility, doctor or supplier accepting new Medicare patients. While most medical services are covered by Medicare at 80% of the plan benefit for each specific service, unless you have Supplemental Insurance or a Medigap Policy, you are responsible for paying the portions not covered by Medicare, which are your annual deductible and a coinsurance payment of the unpaid 20% balance of the Medicare plan benefit.

Medigap and Supplemental insurance policies are available for an additional monthly premium. Supplemental plans will pay the Medicare deductible and the 20% coinsurance charges for services and products. Participating providers will accept both your Medicare and Supplemental insurance as payment in full. Medigap Plans A through L offer you 12 different standardized plans from which to choose. Each of these plans provides different levels of benefits to give you the option of choosing the one best suited to your health and your budget. Before choosing any Supplemental or Medigap policy, visit Medicare's web site, www.medicare.gov where you will find additional information, answers to your questions, and help in selecting the best plan to suit your individual medical needs.

Medicare Parts A and B (annual deductible and coinsurance applies):

Part A - Hospital Benefits: this portion of Medicare helps to pay for inpatient hospital care, a skilled nursing facility following a hospital stay, some health care and hospice services. Additional charges are incurred for lengthy stays.

Part B - Physicians, Medical Services and Supplies: this part of your Medicare coverage helps to pay your doctors allowable charges and other covered expenses for medical services and supplies not included in Part A.

Medicare Parts C and D:

Part C includes the Medicare Advantage plans. Eligibility in Medicare Part A and Part B is required to join these plans. They offer coverage for all of your eligible Medicare services, and, depending upon which plan you choose, you may also receive benefits for prescription drugs and dental services. Some Medicare Advantage plans offer lower co-payments than the Original Medicare Plan, however, your choice of doctors or hospitals may be limited to those who are on their participating provider list.

Medicare Advantage Plans include Medicare Health Maintenance Organization or HMO's, Preferred Provider Organizations, known as PPO's, Private Fee-for-Service Plans, and Medicare Special Needs Plans. Information on each of these plans can be found by visiting Medicare's website, www.medicare.gov

Medicare Part D covers prescription drug benefits. You are charged a separate premium for this coverage that is automatically deducted from your monthly social security benefit. Humana, for example, is one provider of prescription drug benefits offering very reasonable rates with several types of coverage from which to choose. There is a vast difference between the benefits offered and the amount of the premiums charged by the many different providers of prescription drug benefits, so I suggest that you visit Medicare's website, www.medicare.gov to compare all available plans in your area before making your selection. When checking each individual plan, in addition to policy costs, view their benefits for your current prescriptions to determine the coverage for your medications and the amount you will be responsible for paying. If your medication is not covered, check to see if there is a benefit for the generic brand.

As with any insurance coverage, there are certain services considered non-allowable charges that you are required to pay in full. There will always be flaws and portions of health plans with which we disagree, but overall, Medicare offers significant health benefits for seniors and the disabled.

Learn more about this author, V T DeLeo.
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