b' Wordw w w. w m i m u t u a l . c o mMedicare B a sic s .By David Leo, TThe origi-Part B (Medical Insurance)Medicare Part B helps cover Those of us in our middle to later years have lived nearly our entireservices from doctors and other health care providers, hospital lives in the Medicare era. outpatient care, durable medical equipment, and home health nal Medicare law, which was enacted bycare. It also covers many preventive services, screenings, and Congress and signed by President Lyndonimmunizations. Medicare Part B does not, however, include President of B. Johnson on July 30, 1965, included twocoverage for prescription drugs which are covered under Part D WMI Mutual parts: Part A (hospital insurance) and Partof Medicare (see below). There is a Medicare Part B deductible Insurance Company B (medical insurance). Those two parts,($233 in 2022) and there is a monthly premium for Medicare & WMI TPAwhich will be explained in greater detailPart B that varies based on income. The standard Medicare Part below, have cleverly come to be known asB premium amount in 2022 is $170.10 per month, but wealthier Original Medicare. seniors will pay more (up to $578.30 per month in 2022). Part C (Medicare Advantage)Medicare Part C is also known In the years since the passage of the law, Medicare has become a fixture in our country with over 62 millionas Medicare Advantage. This part of Medicare is a substitute for Americans relying upon this vital program for theirOriginal Medicare and is run by private insurance companies health care. Despite a general familiarity with Medicare,rather than the government. It includes all benefits and services most Americans dont fully understand what it is or howcovered under Part A and Part B, and it usually includes cover-it works. Although this brief article doesnt adequatelyage for prescriptions drugs (Part D). Medicare Advantage plans address the many complexities of Medicare, it shouldoften include other benefits and services (some at no additional give the reader a basic understanding of the program andcost) (e.g., fitness center access, SilverSneakers programs, how it operates in conjunction with various Medicare dental care, eyeglasses, and wellness programs). In exchange for Supplement (i.e., Medigap) insurance policies andthe additional benefits, Medicare Advantage participants must Medicare Advantage plans. Much of the information Igenerally accept restrictive provider access or other coverage have presented in this article comes from two publica- limitations and must pay a copayment or coinsurance every time tions offered by the Centers for Medicare & Medicaidthey visit a doctor. Most Medicare Advantage plans require a Services (CMS): (1) Medicare & YouThe Officialmonthly premium in addition to the Medicare Part B premium U.S. Government Medicare Handbook (2022) (medicare. that is paid to the government; however, some Medicare Advan-gov/media/10991); and (2) Choosing a Medigap Policy:tage plans pay all or part of the Part B premium.A Guide to Health Insurance for People with Medicare Part D (Prescription Drug Coverage)Medicare Part D is (2021) (medicare.gov/media/9486). If you would like a free copy of this publication, you can contact me or youthe prescription drug part of Medicare. It is run by Medicare-ap-can download one directly from the CMS website.proved private insurance companies, and it helps cover the cost of outpatient prescription drugs. There are two ways to get prescrip-What is Medicare? tion drug coverage under Medicare Part D: (1) a stand-alone plan Medicare is the federal insurance program that providesthat offers a separate prescription drug plan (PDP) which is health insurance to: (a) people age 65 or older; (b) peopleavailable to individuals who are entitled to Medicare benefits; and under age 65 with certain disabilities; and (c) people of(2) a Medicare Advantage prescription drug plan (MA-PD) that any age with end-stage renal disease (ESRD) covers prescription drugs as part of the Medicare Advantage (Part (permanent kidney failure requiring dialysis or a C) coverage. Stand-alone drug plans help pay for outpatient pre-kidney transplant).scription drugs and vaccines (subject to deductibles, coinsurance and/or co-payment amounts). Medicare Advantage drug plans What are the various components integrate prescription drug coverage and coordinate care and costs of Medicare? with other Medicare benefits into one plan. Part A (Hospital Insurance)Medicare Part A helpsMedicare Part D drug plans are allowed to have a deductible (upcover inpatient hospital care, skilled nursing facilities,to $480 in 2022), and although Medicare drug plans no longer hospice, and home health care. When Medicare Part Ahave a donut hole during which time the member is responsible is coupled with Medicare Part B, the coverage is knownto pay 100% of the drug costs, they do still have a coverage as Original Medicare in contrast to Medicare Ad- gap (from $4,430 spent on covered drugs (but not premiums) to vantage (Part C) plans which are described in greater$7,050 spent in 2022) during which time the member is respon-detail below. There is a Part A deductible ($1,556 insible to pay up to 25% of the cost of the drug. Once you are out 2022), which is covered by all Medigap plans, and mostof the coverage gap, you are only responsible to pay a small people get Medicare Part A coverage for free.48 www.wpma.com / Winter 2021'