If you’re frustrated by trying to decipher the ins and outs of Medicare, you are certainly not alone. Trying to figure out which senior care services Medicare does and does not cover or trying to determine if Medicare will or will not pay for a portion of your loved one’s Oklahoma assisted living services, it can seem like you’re drowning in alphabet soup! Here, we’ve compiled some information to help you understand the differences between Medicare Parts A, B, C and D.
Medicare Part A, also known as hospital coverage, covers such medical necessities as hospital stays, care in a skilled nursing facility, in-home health care and hospice. Medicare Part A is “original Medicare.” Anyone who has been gainfully employed and paid their Social Security taxes for a decade or more receives Medicare Part A coverage for free. Anyone who has worked and paid Social Security taxes for less than 10 years can be covered by Medicare Part A, but they will have to pay a premium. Unfortunately, Medicare Part A does not cover Oklahoma assisted living services that are not deemed medically necessary. Because individuals who receive Medicare assistance must pay 20 percent of their bills out-of-pocket, many seniors purchase supplemental insurance to cover that contribution.
Medicare Part B, also known as medical coverage, pays for doctor’s visits needed to diagnose, treat or cure an illness; preventive care, also known as wellness visits; medical equipment; outpatient services; lab tests; X-rays; clinical research; ambulance transport; and inpatient and outpatient behavioral healthcare services. Patients pay a premium each month to receive this coverage. The amount of the premium is based on the covered individual’s prior year’s gross income.
Medicare Part C refers to the provision allowing private insurers to offer Medicare benefits via private HMO and PPO healthcare plans called Medicare Advantage Plans (MAPs). MAPs are required to offer benefits equal to or better than Medicare Part A and Part B. Private providers are allowed to specify their own fees, rules and coverage exclusions. Individuals covered by a MAP pay a monthly premium.
In this case, D stands for Drug Coverage. Medicare Part D is available only from private insurers who contract with the government. Medicare Part D is not offered by the government directly. While Medicare Part B actually does cover some prescription drugs, most seniors covered by Medicare decide to purchase additional drug coverage through Medicare Part D.
If Medicare confuses you, rest assured, you’re not alone! Making sense of all of the red tape surrounding senior care can be tough. If you are in the process of considering assisted living options in OKC, we would like to do what we can to ease some of your burden. We encourage you to contact us today at Village at Oakwood. We would love to show you around and answer any questions you may about Oklahoma assisted living!