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Medicare is a federal health insurance program for people aged 65 or older and younger people with disabilities such as end stage renal disease that are under 65. It is under the Social Security Administration and is administered by the Centers for Medicare and Medicaid services.
Medicare is divided into 4 parts A, B, C, and D. Part A covers hospital insurance. It covers any tests or services you need during an inpatient stay and Hospice. It also provides limited coverage for skilled nursing facilities and certain home health services.
Part B covers outpatient diagnosis, treatment, and prevention of medical conditions. It includes visits to the emergency room as well as preventive healthcare such as doctor visits, screening and diagnostic tests and some vaccinations. It also may cover some medications.
Part C Medicare Advantage covers inpatient hospital care, limited stay at a skilled nursing facility, limited stay at an inpatient rehabilitation facility, outpatient care at a doctor’s office, urgent care, or clinic. It also covers inpatient and outpatient mental health services, preventive care, including routine exams, shots, labs tests and screenings. Limited outpatient prescription drugs, durable medical equipment, and ambulance services are also covered.
Part D is prescription drug coverage, it helps to pay for medications, and it depends on its formulary and tier system for cost.
The open enrollment period for 2027 is fast approaching. It is from October 15th through December 7th. This is an especially momentous time of year for people who are enrolled in Medicare. This is when a recipient of Medicare can review their coverage and make changes if needed.
The new coverage begins on January 1, 2027 but any changes that one wants to make should be made between October 15th and December 7th.
So, why would one want to review their coverage or make changes? Well, the most important reason is that one should examine the coverage he/she has and make sure it is adequate and takes care of one’s needs.
Does your plan cover the medications that you need? Are there new features to the plans that may be great for you? Has there been a change in the plan that you have, and your doctor and specialists are no longer in the plan? These are all things one may want to look at and determine.
During this enrollment time, one may switch to a plan that better fits one’s needs.
Make sure that you review any and all notices that you get from Medicare.
Take the time to list all of your needs and make sure that what you have will take care of them.
There are agencies in each state that will look at your medical problems, look at the medications that you need and help you find a plan that works for you. This can be found out free of charge and without obligation. In North Carolina, the agency is known as SHIIP (Seniors Health Insurance Information Program). The number is (855) 408-1212. SHIIP offers unbiased information to help you find the best plan for you. Certainly, one may also use an insurance broker to help with this.
The bottom line is you want to take the time to review the plan you have to make sure that you are getting the best plan that you can possibly get for the money. Insurance can be high in cost. Find the one that works best for you.
Dr. Veita Bland is a board-certified Greensboro physician and hypertension specialist. Dr. Bland’s radio show, “It’s a Matter of Your Health,” can be heard live on Wednesdays, 5:30 p.m. on N.C. A&T State University’s WNAA, 90.1 FM. Listeners may call in and ask questions. The show is replayed on Sirius 142 at 5 p.m. on Wed. Email Dr. Bland at ideas@blandclinicpa.com.
