Welcome to Medicare!
October 15 to December 7 – Is Open Enrollment Time
I’m Dolores Dunbar and I have worked in the El Paso and Southern New Mexico Medical community for over 30 years in a variety of healthcare areas. Let me help you navigate through all the Medicare options and changes for 2024. I will customize your needs to the best available health plan.
You should know that Medicare is a government national health insurance program in the United States, begun in 1965 under the Social Security Administration (SSA) and is now administered by the Centers for Medicare and Medicaid Services (CMS). It primarily provides health insurance for Americans aged 65 and older but also for some younger people with disability status as determined by the SSA, including people with end-stage renal disease and amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease).
Medicare Basics
Medicare is divided into four Parts: A, B, C, and D.
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Part A covers hospital, skilled nursing, and hospice services.
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Part B covers outpatient services.
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Part C allows patients to choose an alternative plan that provides the same services as Parts A and B, but also includes additional benefits.
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Part D covers self-administered prescription drugs.
If you have Original Medicare Parts A and B, you can go to any doctor or hospital accepting Medicare as payment for their services if enrolled in Original Medicare. However, outside of preventive screenings and tests usually covered under Part B of your Original Medicare plan, you may need additional coverage to help pay for treatments not covered by Part A or Part B.
This could involve enrolling in a Medicare supplement policy such as Medigap or a private provider-offered policy like an Advantage Plan or a stand-alone prescription drug plan like Part D to help bridge the gaps of coverage not provided under original Medicare.
Medicare does not cover everything!
Unfortunately, the Medicare program does not cover many services that seniors consider "necessary."
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For example, it does not cover vision exams, most dental services (including dentures), and hearing aids. It also does not cover an annual physical exam.
Most notably, it does not cover Long Term Care.
Most of these services are considered "custodial care." They include basic daily activities like help with walking, getting in and out of bed, dressing, bathing, toileting, shopping, eating, and taking medicine. Part A only covers up to 100 days of skilled nursing home care during a benefit period following a hospital stay. If you need long-term custodial care after your hospital stay has ended, Medicare will not pay for it. Additionally, it does not cover homemaker services or private-duty nursing care.