Ezratty: SHIP counselor provides Medicare answers for Sun City residents

Question: What exactly does Medicare parts A, B, C and D cover?

Answer: Part A — Provides in-patient care in a hospital, skilled nursing facility, anesthesia, hospice and home health care (does not cover emergency room) and usually has no monthly premium. If you are not eligible for free Part A due to a lack of working quarters, you may be eligible to pursue it for a monthly cost of between $252 to $458. Hospice services are paid in full by Medicare. Hospital copays vary with Medicare Advantage plans and are covered in full with Medicgap plans G and F.

Part B — Medicare insurance covering doctor’s services, out-patient care (hospital emergency room and up to two night in observation in the hospital), home health services, labs, x-rays and many preventative services. Medicare charges a monthly premium of $144,60 with an upward sliding scale and is usually deducted from your Social Security check. Medicare pays about 80% of a medical fee, leaving about 20% to be paid by your secondary insurance; your plan may have a copayment as well for you to pay. The copayment cost varies with insurance carriers. For example, a Medigap plan G and F pays your entire copay. With a Medicare Advantage plan, your insurance pays most of the copay, leaving a specified amount for your to pay. These out of pocket copays differ from plan to plan. In addition, there is an annual Medicare deductible of $198, which gets rolled into Medigap plans and Medicare Advantage plans. Part B also covers durable medical equipment, such as home oxygen equipment, hospital beds, walkers, wheelchairs, prosthetic devices, braces, catheters and more. The payment formula followed for durable medical equipment is 80% paid by Medicare and 20% paid by you, the beneficiary. Your doctor will complete a DME request and submit it to the registered supplier covered in your area, who will call you regarding delivery and payment.

Part C — A Medicare Advantage plan. There are plans that bundle A, B and D together. Each plan must offer the same basic services as authorized by Medicare, but copays and out of pocket expenses differ by plan. The 2021 plans are offering many perks, including dental maintenance (cleaning), eye exams, eye glasses, fitness club memberships, free over the counter medical supplies, free transportation to medical visits and various rewards programs.

Part D — This is for a drug plan that will be addressed seperately. Please call me with your questions.

During the COVID-19 pandemic, community centers are closed. As your State Health Insurance Assistance Program counselor, I will be happy to address your concerns over the phone. Call 623-866-4214.

Editor’s Note: Roberta Ezratty is a certified State Health Insurance Assistance counselor.