Council on Aging Answers 2017 - 102

Medicare:
Complex and Confusing
COUNCIL ON AGING - SOUTHERN CALIFORNIA

INSURANCE

n Mary Ozurovich
Coordinator of Volunteers: HICAP Orange County

Medicare is complex and confusing - many people
struggle to understand how to navigate its complexities.
The Council on Aging's Health Insurance Counseling
and Advocacy Program (HICAP) is a free service to
help you understand and maximize your Medicare
benefits. Funded in part by CMS (Center for Medicare
& Medicaid Services), HICAP is a 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. Let's start with the basics.
Medicare is a federal health insurance program for:
n Most people aged 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
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
102

Answers Guide 2017

The 4 Parts of Medicare

Part A - Hospital Insurance: Covers most
inpatient hospital care, certain inpatient skilled
nursing facility (SNF) care, certain home health care
and certain hospice care.

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.

3.
4.

Part C - Medicare Advantage: Medicare
benefits through private health insurance plans
such as HMO or PPO plans.

Part D - Prescription Drug Coverage: Provides
prescription drug coverage through private
drug plans.
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. 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

Enrollment Period to enroll in Medicare Parts A and
B. This begins 3 months before your birth month
(not your actual birthday), your birth month and 3
months after your birth month.
n If you, or your spouse, continue to work after

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