b' Wordw w w. w m i m u t u a l . c o mMEDICARE BASICSBy David Leo, T Medicare, theas opposed to Medicare Advantage (Part C) plans Those of us in our middle to later years have lived nearly our entirewhich are described in greater detail below. Most President of people get Medicare Part A for free.WMI Mutual lives in the Medicare era. law enacted by Congress and signed by President Insurance Company Part B (Medical Insurance)Medicare Part B & WMI TPALyndon B. Johnson on July 30, 1965, included twohelps cover services from doctors and other health parts when it was passed: Part A (hospital insurance)care providers, hospital outpatient care, durable and Part B (medical insurance). Those two parts,medical equipment, and home health care. It also which will be explained in greater detail below, havecovers many preventive services, screenings, and come to be known as Original Medicare. immunizations. Medicare Part B does not, however, include coverage for prescription drugs which are In the years since the passage of the law, Medicare hascovered under Part D of Medicare (see below). become a fixture in our country with nearly 60 millionThere is a premium for Medicare Part B thatAmericans relying upon this vital program for theirvaries based on income. The standard premium health care. Despite a general familiarity with amount (2019) is $135.50 per month, but wealth-Medicare, most Americans dont fully understandier seniors must pay more (up to a maximum of what it is or how it works. Although this brief article$460.50 per month).doesnt adequately address the many complexitiesPart C (Medicare Advantage)Medicare Part C of Medicare, it should give the reader a basic un-derstanding of the program and how it operates inis also known as Medicare Advantage. This part of conjunction with various Medicare Supplement (i.e.,Medicare is a substitute for Original Medicare and Medigap) insurance policies and Medicare Advantageis run by private insurance companies rather than plans. Much of the information I have presented inthe government. It includes all benefits and services this article comes from the 2019 publication by thecovered under Part A and Part B, and it usually Centers for Medicare & Medicaid Services (CMS)includes coverage for prescriptions drugs (Part D). entitled Choosing a Medigap Policy: A Guide toMedicare Advantage plans often include other ben-Health Insurance for People with Medicare. If youefits and services at no additional cost (e.g., fitness would like a free copy of this publication, you cancenter access, SilverSneakers programs, dental care, contact me or you can download one directly fromeyeglasses, and wellness programs). In exchange the CMS website at https://www.medicare.gov/Pubs/ for the additional benefits, Medicare Advantage par-pdf/02110-Medicare-Medigap-guide.pdf ticipants must generally accept restrictive provider access or other coverage limitations and must pay What is Medicare? a copayment or coinsurance every time they visit a Medicare is the federal insurance program that pro- doctor. Most Medicare Advantage plans require a vides health insurance to: (a) people age 65 or older;monthly premium in addition to the Medicare Part B (b) people under age 65 with certain disabilities; andpremium that is paid to the government.(c) people of any age with end-stage renal diseasePart D (Prescription Drug Coverage)Medicare (ESRD) (permanent kidney failure requiring dialy-sis or a kidney transplant).Part D is the prescription drug part of Medicare. It is run by Medicare-approved private insurance What are the companies, and it helps cover the cost of outpatient Various Components of Medicare? prescription drugs. There are two ways to get pre-Part A (Hospital Insurance)Medicare Part Ascription drug coverage under Medicare Part D:(1) a stand-alone plan that offers a separate helps cover inpatient hospital care, skilled nurs-ing facilities, hospice, and home health care. Whenprescription drug plan (PDP) which is avail-Medicare Part A is coupled with Medicare Partable to individuals who are entitled to Medicare B, the coverage is known as Original Medicarebenefits; and 16 www.wpma.com / Winter 2019'