HIMPower Magazine HimPower March 2018 | Page 28

PART B: MEDICAL INSURANCE Part B medical insurance helps pay for some services and products not covered by Part A, generally on an outpatient basis (but also when on an unadmitted observation status in a hospital). Part B is optional and may be deferred if the beneficiary or his/ her spouse is still working and has group health coverage through that employer. There is a lifetime penalty (10% per year on the premium) imposed for not enrolling in Part B unless actively working and receiving group health coverage from that employer, or covered by programs of the Veterans Health Administration. Part B coverage begins once a patient meets his or her deductible ($183 for 2017), then typically Medicare covers 80% of the RUC-set rate for approved services, while the remaining 20% is paid by the patient, either directly or indirectly by private group retiree or Medigap insurance. Part B also helps with durable medical equipment (DME), including canes, walkers, lift chairs, wheelchairs, and mobility scooters for those with mobility impair- ments. Prosthetic devices such as artifi- cial limbs and breast prosthesis following mastectomy, as well as one pair of eyeglasses following cataract surgery, and oxygen for home use is also covered. PART C: MEDICARE ADVANTAGE PL ANS Public Part C Medicare Advantage health plan members typically usually also pay a monthly premium in addition to the 28  HimPower March 2018 Medicare Part B premium to cover items not covered by traditional Medicare (Parts A & B), such as the OOP limit, prescription drugs, dental care, vision care, annual phys- icals, coverage outside the United States, and even gym or health club memberships as well as—and probably most importantly— reduce the 20% co-pays and high deduct- ibles associated with Original Medicare. PART D: PRESCRIPTION DRUG PL ANS Medicare Part D went into effect on January 1, 2006. Anyone with Part A or B is eligible for Part D, which covers mostly self-administered drugs. It was made possible by the passage of the Medicare Modernization Act of 2003. To receive this benefit, a person with Medicare must enroll in a stand-alone Prescription Drug Plan (PDP) or Medicare Advantage plan with integrated prescription drug coverage (MA-PD). These plans are approved and regulated by the Medicare program, but are actually designed and administered by private health insurance companies and pharmacy benefit managers. Unlike Original Medicare (Part A and B), Part D coverage is not standardized (though it is highly regulated by the Centers for Medi- care and Medicaid Services). Plans choose which drugs they wish to cover (but must cover at least two drugs in 148 different categories and cover all or "substantially all" drugs in the following protected classes of drugs: anti-cancer; anti-psychotic; anti-con- vulsant, anti-depressants, immuno-suppres- sant, and HIV and AIDS drugs). The plans