Understanding Your Medicare Benefits from A to D

Sunrise Senior Living  |  December 6, 2018
Understanding Your Medicare Benefits from A to D
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Whether you are a new Medicare recipient or a senior who has been using this program for years, one thing older adults often have in common is a lack of understanding about Medicare. From Medicare part A to Medicare part D, the benefits can be tough to navigate. Seniors often wonder what all those letters mean.

Here’s a quick overview with resources to help you learn more.

What is Covered by Medicare Part A?

Medicare Part A is sometimes referred to as the “hospital benefit.” Hospital stays account for a large portion of Medicare Part A, but it also helps pay for the following:

  • Short-term rehabilitation at a skilled nursing center: For adults with traditional Medicare, the Part A benefit will fully cover the first 20 days of short-term inpatient rehabilitation for patients who qualify. Beginning on day 21, a co-pay will be assessed. The co-pay amount typically changes each year.
  • Hospice care: Many people think hospice care is just for the last few days or weeks of life. In reality, the Medicare hospice benefit can cover care for six months (sometimes longer), as long as the patient still meets the hospice criteria. Hospice is a form of comfort care designed to meet the patient’s physical, emotional, and spiritual needs. Many hospice programs utilize non-traditional therapies like art, massage, and music to help patients find peace.
  • Skilled home health services: A senior who has been hospitalized for an illness, injury, or surgery might need to continue their recovery after they are discharged from the hospital. Using their Medicare home health benefit, they can access skilled nursing, physical therapy, speech therapy, and other services in the privacy of their own home. There are conditions that must be met for a senior to use these benefits. The hospital social worker or your primary care physician can help you learn more.

You can review your hospital coverage in more detail by visiting the official Medicare website.

Understanding Medicare Part B

Medicare Part B is designed to cover two primary types of care:

  • Medically necessary services
  • Preventive services.

Services and supplies covered under Medicare Part B can include the following:

  • Doctor’s office visits to diagnose, treat, prevent, or cure a health problem
  • Transportation by ambulance during an emergency
  • Outpatient rehabilitation
  • Durable medical equipment
  • Inpatient or outpatient mental health diagnosis or treatment
  • Preventive screenings and vaccines (e.g., mammograms, flu shots)
  • Laboratory testing
  • Cardiac rehabilitation
  • Some diabetic supplies and counseling services.

Medicare Part C: Medicare Advantage Plans

Private insurance companies can contract with Medicare to provide health care services to seniors. These are called Medicare Advantage plans. Your care will still fall under the umbrella of Medicare, entitling you to the same rights and protections as a senior enrolled in traditional Medicare.

You will be required to follow the plan’s rules, such as getting  pre-authorization for some procedures or going to physicians that are part of the plan. Seniors who are considering a Medicare Advantage plan should make sure their preferred providers are part of the plan.

Older adults often find Medicare Advantage plans to have lower out-of-pocket costs, making them a budget-friendly solution. Many even include prescription drugs in the plan. One example is Sunrise Advantage Plan, currently offered to seniors in parts of Illinois, New York, Pennsylvania, and Virginia.

Medicare Part D: Prescription Drug Coverage

If you opt for traditional Medicare instead of a Medicare Advantage plan, you can still sign up for prescription drug coverage. This falls under Medicare Part D. In most cases, you need to sign up for drug coverage at the time you enroll in Medicare or you will pay a penalty.

You can use the Medicare Plan Finder to investigate drug coverage options near you.

See Your Doctor Once Each Year

One Medicare benefit that many seniors may be unaware of is the annual wellness visit. You can read “What is the Medicare wellness visit, and how much does it cost?” to learn more.