Definition of Medicare ABCD

Source: NYSUT Social Services

Medicare: Federal health insurance program for persons 65 years of age or older, the disabled and those with end- stage renal disease.

Within Medicare there are services linked to categories ( A, B C, D)

Medicare A: Helps cover inpatient care in hospitals. This includes critical access hospitals and skilled nursing facilities (not custodial or long-term). It also helps cover hospice care and home health care. You must meet certain conditions to get these benefits. Most people automatically get Part A coverage without having to pay a monthly payment or premium.

Medicare B: Helps cover medical services like doctor's services, outpatient care and other medical services that Part A does not cover. Part is voluntary and you pay a premium each month. Usually the premium is automatically deducted from you monthly social security check. Although this part is voluntary it is recommended that everyone participate in Part B regardless of whether or not you have additional secondary insurance coverage. The only exception is when you are working full-time and are receiving insurance benefits from your employer who is employing 20 or more employees.

Medicare C: Refers to Medicare Advantage Plans (ie. HMOs and PPOs) that are health plan options that are approved by Medicare and run by private companies. They are part of the Medicare program and have special benefits like lower premium or cost of services

(co-pays). Many plans also include Part D drug coverage. These plans have networks, which means you have to see who belong to the plan or go to certain hospitals to get covered services. Individuals who do not have secondary insurance may choose to use these plans however it is important to remember that coverage is limited to networks while with original Medicare you are only limited by physicians who do not accept Medicare.

Medicare D: Helps pay for prescription drugs. You must choose between several plans that are offered in your area. Each plan has different formularies of drugs that are offered. You would choose a plan based on what your prescription drug needs may be. The coverage is voluntary and there is a monthly premium. The premium cost is dependent on the prescription drug plan that you choose. If you have a secondary insurance that includes prescription coverage you do not have to sign up for Medicare D.

Note:It is important to note that if you are eligible for Medicare B and chose not to sign up at the time of eligibility you may end up paying a penalty on your monthly premiums once you enroll. Remember the only exception to this is if you are employed and have insurance coverage through you employer.

If you should choose not to sign up for Medicare D without having a pre-existing prescription drug plan, you will have to pay a penalty on your monthly premiums.

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