Medicare Simplified

Medicare is, very simply, America’s health insurance program for people age 65+ and those under age 65 with certain disabilities. Medicare has provided valuable benefits to older Americans for the past 47 years. 

Medicare has four parts:

  • Part A - hospital insurance
  • Part B - medical insurance
  • Part C - also known as Medicare Advantage Plans
  • Part D - prescription drug coverage.

Most people get Part A automatically when they turn age 65. They don't have to pay a monthly premium for Part A because they or a spouse paid Medicare taxes while they were working. Most people pay monthly for Part B. There are also costs associated with Parts C and D. 

In general, people enrolling in Medicare can either:

  • Enroll in Parts A and B (called “Original Medicare”), then consider purchasing Part D and/or a Medicare Supplement (Medigap) plan, or
  • Enroll in a Medicare Advantage Plan, which combines Part A, Part B, and usually Part D. These plans are offered by private companies. 

For 2013 plans, the annual enrollment period for Medicare products is October 15, 2012, to December 7, 2012.

Blue Cross and Blue Shield of Nebraska has offered Medicare Supplement health plans to Nebraskans since the program was introduced in 1966. In 2013, the company will offer both a Part D prescription drug plan and six Medicare Supplement (Medigap) plans. To learn more, call 877-444-2583.

HEALTH INSURANCE TERMS

Affordable Care act

The Affordable Care Act (ACA), sometimes called Obamacare, is a federal law designed to make health care more affordable, accessible and of higher quality.

COINSURANCE

The percentage of the bill you pay after your deductible has been met.

COPAY

A fixed amount you pay when you get a covered health service.

DEDUCTIBLE

The annual amount you pay for covered health services before your insurance begins to pay.

emergency care services

Any covered services received in a hospital emergency room setting.

health insurance marketplace (exchange)

The government Website (healthcare.gov) where you can purchase health insurance and see if you qualify for a tax credit (subsidy) to help pay premiums and out-of-pocket costs. 

in-network provider

A provider contracted by your insurance company to accept an agreed upon payment for covered services. 

OUT-OF-network provider

A term for providers that aren’t contracting with your insurance company. (Your out-of-pocket costs will tend to be more expensive if you go to an out-of-network provider.)

out-of-pocket

Your expenses for medical care that aren’t reimbursed by insurance, including deductibles, coinsurance and co-payments.

penalty

If you can afford health insurance, but choose not to buy it, you must have a health coverage exemption or pay a tax penalty on your federal income tax return.

premium

The amount you pay to your health insurance company each month. 


Preventive services

Health care services that focus on the prevention of disease and health maintenance.

rehab SERVICES

Services and devices to help you recover if you are injured or have surgery. This includes physical, occupational and speech therapy.

special enrollment period

The time after the Open Enrollment Period when you can still purchase health insurance only if you have a qualifying life event (losing other health coverage, having a baby, getting married, moving).

specialist

A physician who has a majority of his or her practice in fields other than internal or general medicine, obstetrics/gynecology, pediatrics or family practice.

SUBSTANCE ABUSE DISORDER SERVICES

Includes behavioral health treatment, counseling, and psychotherapy.

tax credit

Financial assistance from the government that helps those who are eligible pay for health insurance. Eligibility is generally determined by household income and family size.

Tiered benefit plan

A health care plan featuring multiple levels of benefits based on the network status of a particular provider.