Your Health: Talking about the ABCD’s of Medicare

With all the different letters names, Medicare can be a confusing system to navigate. Medicare is a federal health insurance for people 65 years of age and older and some people younger than 65 with certain conditions or disabilities. Medicare open enrollment occurs annually from October 15th through December 7th allowing members to choose an insurance plan that is right for them for the following calendar year. After December 7th, it can become more challenging to change Medicare Part D plans, so here are some important things to know.

There are three primary parts of Medicare. Part A covers care in hospitals, skilled nursing facilities, hospice, and home healthcare. Part B covers outpatient care, durable medical equipment, and preventative services including some vaccines and disease screenings. Part D helps to cover prescription drug costs and some vaccines.

There are two ways to obtain Medicare coverage. Original Medicare includes Medicare Part A and Medicare Part B. You can add drug coverage with a separate Medicare Part D plan. With Original Medicare, you can use any doctor or hospital that accepts Medicare insurance. The other way to obtain Medicare coverage is with Medicare Part C, more commonly known as Medicare Advantage. This insurance plan is offered by a private company and includes Part A, Part B, and can inlcude Part D. A drawback of Medicare Advantage is that you can only see providers who are in the plan’s network. However, the plan may offer extra benefits such as vision, hearing, and dental coverage.

When navigating Medicare, there are a few key terms to understand. A premium is the amount of money you pay each month to the insurance plan. It is paid monthly to keep your insurance plan active. A deductible is the amount you need to pay before insurance will start helping to pay for medical costs, this resets every year on January 1st. For example, if you have a $500 deductible, you will need to spend $500 of covered services before insurance will start to help pay. After this, you will typically see a decrease in your healthcare costs for the year.

Each Medicare Part D plan covers medications differently, so your most affordable drug plan is unique to you. This means that the plan that is best for you may be different than the plan that is best for your spouse or friend. There are multiple resources available to determine your most cost-effective drug plan including the Medicare.gov website, your local pharmacy, or your local senior center. Give them a call for help finding your most affordable drug plan.

Brianna O’Gary is a 4th year pharmacy student who is working under pharmacist Kelsey Ihry at NuCara Pharmacy in Valley City, North Dakota.

Your Health is coordinated by CityCounty Health District.