By Barry Klitsberg
Enrollment in Medicare can be a lifesaver, but understanding your coverage can be difficult. Family and Children’s Association’s Free Nassau County Health Insurance Information Counseling and Assistance Program can help you get the most from your Medicare plan with free guidance by phone.
Medicare offers preventive health service coverage for a variety of chronic conditions. For example, Medicare can cover medical nutrition therapy services if you have diabetes or kidney disease, or if you have had a kidney transplant in the last 36 months and your doctor refers you for services.
Only a registered dietician or nutrition professional who meets certain requirements can provide medical nutrition therapy services.
If you have diabetes, you may also be eligible for diabetes self-management training. You pay nothing for medical nutrition therapy preventive services because the Medicare Part B deductible and coinsurance don’t apply.
There are four basic parts of Medicare:
Hospital Insurance (Part A) covers you as an inpatient in a hospital or skilled nursing or rehabilitation facility, or for skilled home care after a hospitalization. Medicare Part A also can cover hospice care if you have a terminal illness. For most people, Medicare Part A is premium free.
Medicare Medical Insurance (Part B) covers physician and other outpatient services. These services include doctor visits, hospital outpatient services, lab tests; physical, speech or occupational therapy; and durable medical equipment for use in the home. The standard Part B premium amount in 2023 is $164.90.
Most people pay the standard Part B premium amount. If your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, you’ll pay the standard premium amount plus an Income Related Monthly Adjustment Amount (IRMAA) charge.
Medicare Part C You may opt for Medicare Advantage plans instead of Part B. Medicare Part C are managed care plans including Health Maintenance Organizations and Preferred Provider Organizations.
These plans generally have a network of providers. In an HMO, you must use providers in that network. If you join a PPO, you can go out of the network, but you will have a higher copayment for out-of-network services.
Medicare Advantage plans generally cover prescription drugs, otherwise covered by Medicare Part D, and frequently cover non-Medicare services such as vision, dental and hearing services.
Medicare Part D is prescription coverage. There are 19 drug plans in New York State. These plans vary in premium cost and formularies.
There are Medicare supplement plans known as Medigap. These are standardized plans that can fill most of the Medicare gaps such as deductibles and co-insurance.
For more information about these Medicare preventive health services and for any other information pertaining to your health benefits, you can call FCA at 516-485-3754 and a trained counselor will assist you.
Barry Klitsberg is an Assistant Health Insurance Information Counseling and Assistance Coordinator at FCA in Garden City and an Aging Services Program Specialist at US Department of Health and Human Services.