UNDERSTANDING MEDICARE IN ILLINOIS
Most people understand that Medicare in Illinois is the federal system of health insurance for people 65 or older and people with certain disabilities. Beyond that, the details start to get more complicated.
The different parts of Medicare can be a little confusing so we’ve broken it down as simply as possible to help explain. After reading through our overview, if you have specific questions and want immediate answers, pick up the phone and call us to have one of our insurance specialists provide clear and helpful answers to get you on the right track.
ORIGINAL COVERAGE (Traditional Medicare)
Medicare Part A is basically hospital insurance. This is insurance that helps cover the costs of inpatient care in hospitals, skilled nursing facility, hospice, and home health care. Medicare Part A coverage is premium-free for most beneficiaries because it is funded by Social Security payroll taxes. However, Medicare Part A does have a deductible and depending on length of stay, daily charges. Enrollment in most cases is automatic and generally information is sent to your home a few months before you turn 65. You’re eligible for Medicare Part A coverage if you or your spouse paid into Social Security for at least 10 years while employed and you are a citizen or permanent resident of the United States.
Medicare Part A helps pay for your hospital stay including, a semi-private room, meals and some other services for up to 150 days. In addition, it helps pay for up to 100 days in a Medicare-certified nursing facility after an inpatient hospital stay of at least three days. Costs for services related to a terminal illness are covered by hospice care. Services not related to the terminal illness are covered by other payment methods from Medicare. Hospice coverage includes drugs, medical and certain support services such as grief counseling. Hospice care is generally available for people with a terminal illness who are expected to live six months or less if the disease runs its normal course.
Medicare Part B is medical insurance – everything outside of room and board and basic nursing while inpatient in a hospital. This is insurance that helps you pay for necessary services like doctor’s visits, outpatient care, home health services, durable medical equipment and lab/diagnostic testing. Generally, you are enrolled automatically in Part B, which carries a premium that is deducted from your Social Security check monthly. If you aren’t collecting Social Security but still take Part B, then Social Security will send you a quarterly premium bill. You always have the option of refusing Part B if you continue to work and have medical benefits or continue to keep benefits upon retirement.
Medicare Part B helps pay for services or supplies that are needed to diagnose or treat medical conditions. In addition, it covers preventive treatment as well. Most routine screenings are covered, including colon cancer, prostate cancer, cardiovascular and diabetes. Other routine testing is covered like pap tests and mammograms, flu and hepatitis B shots. In addition, Medicare Part B covers regular visits to your doctor. Part B offers includes one visit when you first acquire insurance and one visit annually thereafter. Smoking cessation and diabetes nutrition planning is also included in Part B.
- Health plans run by private, Medicare-approved insurance companies
- Include Part A and Part B (above)
- May contain other coverage like Part D prescription drug coverage costs
- A prescription drug option run by Medicare-approved private insurance companies
- Helps cover the cost of prescription drugs
- May help lower your prescription drug costs and help protect against higher costs in the future
- You need Part A and Part B coverage to enroll in Part D
- Insurance plans run by Medicare-approved private insurance companies
- Insurance sold to fill “gaps” in Part A and Part B coverage
- Helps cover deductibles, co-payments and coinsurance
- The right plan will help lower your total out of pocket costs and overall spending on health care
- You need Part A and Part B coverage to enroll in a Medicare Supplement Insurance plan
Understanding Medicare can be confusing. Learning the basics of Medicare Part A and Part B will help you understand which services are covered and which are not. That is why it is beneficial to sit down with one of the licensed insurance specialists at Healthcare Services of Illinois to allow them to navigate the Medicare maze for you.