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Medicare

Medicare is a government health insurance program for people age 65 and older and for people who have end-stage renal disease or ALS, also known as Lou Gehrig’s disease. It has four components – Parts A, B, C, and D. “Original Medicare” is Parts A and B.

Part A – Hospital Insurance

Part A has no monthly premium and covers inpatient care in:

  • Hospitals
  • Skilled nursing facilities
  • Hospice care
  • Some home health care

Any provider who accepts Medicare can be seen.

Part B – Medical Insurance

Part B and is medical insurance that covers:

  • Physician visits
  • Outpatient care
  • Home health care
  • Durable medical equipment such as wheelchairs, hospital beds
  • Preventive care such as screenings, vaccines, and flu shots

It has a monthly premium. It’s very important to sign up for Part B when you are first eligible for Medicare, or you could incur a late enrollment fee, which is added to the monthly premium for the entire time you have Part B. Any provider who accepts Medicare can be seen.

Part C – Medicare Advantage

Part C is more commonly known as Medicare Advantage (MA). These plans provide Part A and Part B coverage combined, and usually include Part D prescription drug coverage. Medicare Advantage plans that include Part D coverage are called Medicare Advantage Prescription Drug (MAPD) plans.

Usually, you’ll need to see healthcare providers who are in the plan’s network. Out-of-pocket costs may be lower than Original Medicare (Parts A and B). Plans may include additional benefits such as vision, dental, and hearing.

Differences Between Original Medicare and Medicare Advantage

Part D – Prescription Drugs

Medicare Part D, also known as Prescription Drug Plan (PDP), is a separate plan and requires separate enrollment. Private companies provide the coverage. Benefits and monthly premiums vary by plan. It’s also important to avoid late enrollment penalties in Part D. If you have a serious illness or chronic disease, it’s important that your drug benefit cover your specific drugs.

Texas Oncology’s pharmacists can help answer your questions about prescription drug coverage, including how it relates to cancer treatment. Texas Oncology cannot recommend a specific plan, but can provide information and key considerations for those undergoing treatment and ongoing maintenance care.

There are many vital considerations when selecting a Medicare Part D plan. Please see our Medicare Part D Fact Sheet for more important information.

Medigap – Medicare Supplemental Insurance

Additional insurance can be purchased from private companies to help cover your portion of costs not covered in Original Medicare, i.e., the 20% coinsurance. Policies are standard and are named by letters in most states. The benefits in each letter plan are the same regardless of the company providing it. For example, all Plan J plans have the same benefits from all companies.

Timing

When and how you sign up matters. If you are nearing age 65, pay close attention to the rules and timing of signing up. For information on initially signing up, review details at Medicare.gov.

Each year, an open enrollment period is available October 15-December 7. It’s your opportunity to review your plan and prescription drug coverage. Plan benefits, amount of coverage, drug plans, and providers included in a plan’s networks can change each year. It’s important to compare your current plan with other options, especially if you have a chronic condition or serious illness such as cancer. If you change plans, new coverage will start on January 1.

Accepted Plans and Other Considerations

For a patient, if you value the care approach of Texas Oncology, which provides integrated care, you will want to pursue a plan that preserves that. Look for plans that include both medical and drug coverage in them. Sometimes providers and pharmacies of the same healthcare organization are not included on a plan. It’s important to confirm that both providers and your preferred pharmacy are included. By not participating in such a plan, it could fragment your care so you can’t get all your care in one place.

Premium costs are always an important consideration, but there are also critical decision points beyond premiums that can outweigh the overall premium cost differences.

Learn more information about the insurance plans Texas Oncology accepts.