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Senior Citizen Insurance - Making the Most of Senior Citizen Insurance - Part A: Basic Services

Medicare

medicare care medical doctors

Most American citizens age 65 or older receive some form of Medicare as part of their senior citizen insurance package. Medicare is a federally funded health care package available to most American citizens. It is divided into four parts, each dealing with a difference aspect of senior citizen insurance. Parts A and B deal exclusively with the government, while Parts C and D combine the federal and private sectors to provide more comprehensive coverage.

Part A: Basic Services

Part A is a basic, premium-free health package that pays mostly for hospital care. A few select nursing facilities, hospices, and home care services are also covered under Part A. To qualify for Part A Medicare, a citizen or a citizen’s spouse must have worked at least ten years in Medicare-covered employment.

Part A provides only the most basic senior citizen insurance. It covers blood transfusions, inpatient hospital care, and up to 190 days of mental health care. Onsite rehabilitation periods of up to twenty days are also provided, with eighty more days available with a small co-pay. Home-use equipment like wheelchairs, oxygen machines, beds, and walkers are also provided under part A.

Note that Part A does not include many of the most expensive parts of medical care. Doctors, labwork, and medicines are not included.

Part B: Hospitalization, Labwork, and Preventative Medicine

Medicare Part B expands on Part A at the cost of a premium—a monthly payment made to an insurance provider (in this case, the government).

In 2010, the base premium for Medicare Part B is $287.30. Income and life-changing events can alter this base fee. As of 2010, single-person households with a modified adjusted gross income (MAGI) of $85,000 or two-person households with a MAGI of $170,000 are required to pay higher premiums.

Life-changing events can also impact monthly premiums for Medicare Part B. Marriage, divorce, widowing, work reduction or stoppage, loss of assets, and loss of income can lead to temporary or permanent alterations. The application for a life-changing event can be found on the Social Security website.

Medicare Part B pays for labwork, ambulance services, vision, emergency rooms, and a wide array of preventative services. It does not cover the doctor’s fees for routine check-ups.

Preventative services are worthy of special mention. The 2009 American Recovery and Reinvestment Act added a long list of senior citizen insurance options to Medicare Part B. From flu shots to cancer screenings to counseling to help quit smoking, the services now provided by Part B have expanded to include medical help designed to prevent sickness rather than treating it as it occurs.

Part C: Doctor’s Fees

While Parts A and B deal exclusively with the government, Medicare Part C is only available through private insurance companies. This takes place in part due to the huge infrastructure necessary to negotiate the prices for Medicare Part C, which deals with paying for doctors, specialists, and other highly-trained practitioners.

Different insurance companies and plans determine which doctors a Medicare Part C beneficiary can visit. Health Maintenance Organizations (HMOs) provide a list of certain doctors which can be consulted, while Preferred Provider Organizations (PPOs) let patients choose doctors outside a list of providers. Private Fee-for-Service (PFFS) plans do not use a list at all. A Medical Savings Account (MSA) grants seniors more control over their Medicare funds in exchange for a higher deductible. Lastly, Special Needs plans cater to certain chronic diseases.

Part D: Prescription Drug Coverage

Medicare Part D equips beneficiaries with a Medicare card that provides financial assistance on prescription drug costs. Assistance takes the form of a co-pay or deductible. Beneficiaries have the option of adding Part D to either their federal or private Medicare plans.

Federally-sanctioned fees punish beneficiaries who sign up for Part D later in life. This system is in place to prevent patients from only paying for Medicare Part D when drugs become necessary after an illness and to reward patients who invest in their future medical security.

Need-based programs like Medicaid exist to provide additional help with prescription drug coverage. Some recipients of senior citizen insurance cannot afford the co-pays or deductibles to get the drugs they need. Fortunately, they can get further federal assistance on this expensive aspect of ongoing medical care.

Getting Started

Medicare dot Gov is the primary site for resources on America’s primary form of senior citizen insurance. It provides ample amounts of insurance, including a 124 page pamphlet on Medicare policies. An eligibility questionnaire lets potential beneficiaries quickly learn what Medicare programs they can potentially apply to prior to filling out the ten minute online application.

Every new Medicare Part B beneficiary is also entitled to a free “welcome to Medicare” doctor’s appointment. During this visit, a Medicare doctor will explain the basics of the Medicare program and make sure that the beneficiary is on a Medicare package that will meet their needs. This appointment also provides a forum where questions can be asked and terms can be clarified as they relate to the patient in question.

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