The Guide To Medicare Coverage For Seniors

Tim Watt  |  August 15, 2014

As seniors approach retirement age, they become eligible for health care coverage under Medicare, a national program for which older adults can apply to help pay portions of certain medical services and bills. While many seniors understand what the program is and when they can apply, few know about its intricacies and how to take full advantage of its features.

If you're meeting with an older adult who would benefit from enrolling in Medicare, consider the ways you can easily break down its features so the senior can understand what they are eligible for and why they should apply. It's important to encourage clients to ask questions, as the program can be complicated for those learning about it for the first time. 

As you start explaining the different plans covered under Medicare, be sure to consult the federal website for more details about certain portions of the program.

Breaking down the basics
Once a senior reaches 65 years of age, he or she can start receiving the benefits of Medicare. There is a seven-month period during which seniors can apply for Medicare: three months before their 65th birthday, their birthday month and three months after. After this time, older adults can still enroll in Medicare, but they may have to pay additional fees. 

There are four different parts of Medicare for which seniors can apply, including A, B, C and D. Parts A and B are covered under Original Medicare, but C and D are considered supplemental plans that can cover additional fees, such as consultations with specialists or particular prescription medications. Once a senior has selected the ideal plan, he or she is not required to adhere to this plan for the rest of their lives - each year, from Oct. 15 to Dec. 7, seniors can change their plans during the Medicare Open Enrollment Period.

What's covered under each plan?
Original Medicare, or plans A and B, covers basic health care costs, including visits to the doctor and stays in the hospital. Additional plans, such as C and D or more specialized options, allow seniors to customize their health care to receive coverage for medications or conditions unique to the individual.

When explaining the basic of each plan to older adults, be sure to stress the following in relation to each:

Part A: Services and resources deemed crucial for one's health

  • Hospital stays
  • Nursing home care
  • Physical health supplies (such as wheelchairs and walkers)
  • Hospice
  • At-home care

Part B: Services and resources used to treat a condition

  • Doctor visits
  • Certain prescribed medications
  • Ambulances
  • Preventative services (such as flu shots or disease screenings)

Part C: Unlike parts A and B, Medicare Advantage Plans are provided by private companies that provide the senior with all the benefits from Original Medicare, but with additional coverage that may pay for certain prescriptions. These plans vary based on the organization that pays the costs, so if seniors are considering this plan, they should compare and contrast different companies and the services they may provide.

Part D: Seniors who require specific medication to treat a chronic or temporary condition should consider enrolling in plan D, or Medicare Prescription Drug Plans, tailored to the individual. These older adults may use the Medicare site to determine which plan will cover the costs for their prescriptions, as these may vary by area. 

Further resources for seniors
As seniors start thoroughly examining the Medicare plans at their disposal, they may wish to use online resources that can help in the decision-making process. The following websites may be useful for older adults looking to further their knowledge about certain plans and what they may cover:

Consider distributing a fact sheet to senior clients, complete with an overview of Medicare plans and additional resources that may aide in the decision-making process.