Cantissimo Senior Living Blog

When Medicare was introduced in 1965, prescription drugs were not covered. However, in December 2003, Medicare Part D was signed into law to cover the cost of medications. Unlike Medicare Part A and Part B, however, Part D is optional.

What Part D Covers

Medicare Part D is offered via plans marketed by private companies. Each plan publishes its own list of covered drugs called a formulary. Formularies contain both brand-name and generic drugs. A formulary typically will have two or more drugs in the most popular categories to allow for more choices.

Formularies are not static. Medicare rules allow a plan to make changes to its formulary and drug fees during the year because:

Some Medicare beneficiaries want more healthcare benefits than Original Medicare can offer, even with Medigap supplemental policies. Medicare Advantage Plans (sometimes known as Medicare Part C) fill this need by providing more benefits for beneficiaries who agree to extra costs and less flexibility.

The Medicare Advantage Alternative

Offered by private insurance companies, Medicare Advantage Plans provide Part A and Part B coverage as an alternative to Original Medicare. Medicare pays a fixed amount to these insurers for each beneficiary enrolled in their plans but requires these companies to follow specific rules. These rules allow the companies flexibility to offer more services. However, to do this, they may handle out-of-pocket costs differently and impose certain restrictions on enrollees.

Original Medicare (Part A and Part B) offers many benefits, but it has some "gaps." The most prominent gap is there is no limit on out-of-pocket expenses, which encompass deductibles, copayments, and coinsurance.

Medigap to the Rescue

One way to fill many of these gaps is through a Medicare Supplement Insurance policy (also known as Medigap) sold by private insurers. Medigap policies come in several different versions but must adhere to strict government standards. These standards allow easier comparisons between policies and protect consumers from unscrupulous insurers.

Along with Medicare Part A, Part B is the other part of Original Medicare. A recent blog post described Medicare Part A coverage for inpatient care (hospital and skilled nursing), hospice care, and home healthcare.

Medicare Part B covers medically necessary costs for:

• Doctors
• Outpatient care
• Home health services
• Durable medical equipment

As noted in a previous Cantissimo Senior Living blog post, Getting Started with Medicare, Original Medicare consists of Part A and Part B. This blog post focuses on Part A, which covers inpatient hospital stays and some other services.

Part A (Hospital Insurance) helps cover:

Most Americans reaching age 65 achieve a significant milestone: Medicare eligibility. Launched in 1965, Medicare is a national health insurance program created and administered by the U.S. government and funded primarily via payroll taxes. Prior to its inception, over half of Americans, 65 or older, had no health insurance.

The program started with coverage for hospital stays (Part A) and other medical expenses like doctor fees (Part B). These two parts, known as "Original Medicare," operate as a "fee-for-service" system where a provider (e.g., hospital or doctor) gets paid for each service delivered.

Planning for long-term care expenses seems to involve a lot of wishful thinking for many. As noted in another Cantissimo Senior Living blog post, a survey found that about half of respondents said they had done little or no planning for these needs.

One example of wishful thinking is that government programs like Medicare or Medicaid will pay long-term care expenses.