Council on Aging Answers 2016 - 84

COUNCIL ON AGING - ORANGE COUNTY

Medicare: Complex and Confusing
n Mary Ozurovich,
Coordinator of Volunteers, HICAP Orange County

INSURANCE

Informed Medicare enrollees get better coverage
Medicare is complex and confusing - many people
struggle to understand how to navigate the complexities of the program.
The Council on Aging's Health Insurance Counseling and Advocacy Program (HICAP) is a no-cost service to help you understand and maximize your Medicare benefits. HICAP is the most dependable source of
unbiased, accurate, and up-to-date Medicare-related
information for Orange County residents.
HICAP helps residents in Orange County understand their Medicare options and assists when a Medicare covered service is denied. The following is basic
information to help start you on the path to a better
understanding of Medicare.
Medicare is a federal health insurance program
for:
n Most people age 65 and older
n Certain people younger than 65 with disabilities
n People with ALS, also known as Lou Gehrig's
disease
n People with end-stage renal disease (ESRD),
permanent kidney failure requiring dialysis or
transplant

84

Medicare is divided into 4 parts:
n Part A - Hospital Insurance: Covers most inpatient hospital care, certain inpatient skilled nursing facility (SNF) care, certain home health care
and certain hospice care.
n Part B - Medical Insurance: Covers a portion
of outpatient medical services such as doctors
services outpatient hospital care, laboratory
tests, outpatient physical and speech therapy,
certain home health care, certain ambulance
services, and certain medical equipment and
supplies.
n Part C - Medicare Advantage: Medicare benefits
through private health insurance plans such as
HMO or PPO plans.
n Part D - Prescription Drug Coverage: Provides
Answers Guide 2016	

prescription drug coverage through private
drug plans.
Note: Medicare does not cover all medical services.
It also does not pay 100% of certain covered services.
Although Medicare pays for many preventive services
and health screenings, as well as providing coverage
for many medically necessary services, the percentage
of your out-of-pocket health care is sizeable and will
increase as you age.
Examples of items Medicare does not cover:
n Hearing aids
n Eyeglasses
n Dental care
n Acupuncture
n Long-term care at home or in a nursing home,
when the care you need is primarily personal
care
n Health care outside the United States
Medicare safeguards to ensure coverage of medically needed services:
n All Part C Medicare Advantage Plans (ex.
HMOs, PPOs) are required to cover the same
services as Original Medicare.
n If you have a Medicare Advantage plan and you
are referred to a specialist, make sure that the
specialist is part of your assigned HMO or PPO.
n When enrolling in a new Part D drug plan you
are entitled to a transition short term prescription for your medication if it is not covered by
your new plan.
n If you disagree with a Medicare health plan or
Part D plan decision, you can have a review of
the decision.
n HICAP provides free help with the appeals process.
When to sign-up for Part A and Part B Medicare:
n When you turn 65, you are entitled to an initial
enrollment period to sign up for Medicare Parts
A and B. This begins three months before your
birth month (not your actual birthday), your birth
month and three months after your birth month.
n If you, or your spouse, continue to work after

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Aging
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| www.adrcoc.org
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Table of Contents for the Digital Edition of Council on Aging Answers 2016

Contents
Council on Aging Answers 2016 - Intro
Council on Aging Answers 2016 - Cover1
Council on Aging Answers 2016 - Cover2
Council on Aging Answers 2016 - 1
Council on Aging Answers 2016 - Contents
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