Medicare is the primary source of health insurance for older people and for individuals who have received Social Security disability benefits for 24 months. About 25 to 30 percent of people with MS are enrolled in Medicare. Medicare works like other health insurance. It pays for a portion of certain necessary medical services. To be covered, the Medicare Act says the services must be reasonable and necessary for the treatment, diagnosis or rehabilitation of an illness, injury or malformed body member. Often cost-sharing is required of the individual Medicare beneficiary, including premiums, deductibles and co-payments.
- The Medicare program is divided into parts:
- Part A covers inpatient hospital care, skilled nursing facilities (nursing homes), home health and hospice care.
- Part B is optional, and requires a monthly premium. This part covers medical care provided by doctors and other health-care providers, long-term home health care, durable medical equipment, outpatient hospital services, physical, speech and occupational therapy.
- Part C, Medicare Advantage, provides different benefits, typically in a managed care setting.
- Part D is a prescription drug program, which started in 2006. Medicare’s prescription drug benefit coverage is provided through third-party health plans and organizations. These are known as Prescription Drug Plans (PDP). Every autumn the marketing information for PDPs begins to hit mailboxes, newspapers and television.
The Annual Enrollment Period for Part D runs from Nov. 15 to Dec. 31. Coverage then starts in January. During this period people with Medicare can enroll in a plan, or change their enrollment from one plan to another. Individuals who are already in a plan should decide whether it will be right for them in the coming year; if they do not switch they will remain in their current plan.
All plans have different costs and benefits from year to year. It is crucial for all beneficiaries to carefully review their options and make the best choices for the coming year.
If you have questions about Medicare and you are a Connecticut resident, contact CHOICES, Connecticut’s program for Health insurance assistance, Outreach, Information and referral, Counseling, Eligibility Screening. Call CHOICES at 800.994.9422 to speak with a counselor in your area. For more information contact Medicare at 800.MEDICARE or visit www.medicare.gov.