What Is Medicare?
Medicare, a federally facilitated health insurance program, is an important coverage option for people with cystic fibrosis, especially adults who are receiving Social Security Disability Insurance (SSDI) payments. If you are no longer able to work due
to treatment burdens or other health-related issues, SSDI might be an option for you.
After two years of receiving SSDI benefits, you will be eligible for Medicare. Most people who receive SSDI do not have to pay for Medicare Part A (sometimes called “premium-free Part A”).
In addition, Medicare could be an option for:
- People 65 years and older who are receiving benefits from the Social Security Administration (SSA) or the Railroad Retirement Board (RRB)
- People younger than 65 years who are receiving SSDI or people receiving certain disability benefits from the RRB
- People with end-stage renal disease (ESRD), which is permanent kidney failure that requires dialysis or transplant
Medicare is broken down into four “parts” that help cover specific services:
Learning how each of these parts works and what services they cover can help you choose the right Medicare plan for you.
Medicare Part A (Hospital Insurance)
The first component of Original Medicare (Medicare Part A) focuses on inpatient care. Each type of Part A services comes with its own set of out-of-pocket expenses and may require you to pay various deductibles, coinsurance, and copayments . Services typically covered
under Medicare Part A include:
- Inpatient hospital care
- Skilled nursing facility care (not custodial or long-term care)
- Hospice care
- Home health care
To see the full list of services covered under Medicare Part A, visit Medicare.gov.
Medicare Part B (Health Insurance)
Medicare Part B, the second component of Original Medicare, focuses on medical services provided outside of hospitals and medical facilities. This includes doctor visits, outpatient services, some preventive care, and other medically necessary services.
Medicare Part B typically covers:
- Services from doctors and other health care providers
- Outpatient care
- Diagnostic tests (blood work) and imaging (X-rays, CT, PET scans, MRIs)
- Home health care (when homebound)
- Durable medical equipment
- Some preventive services
- Ambulance services
- Emergency department services
- Some prescription drugs (most nebulized CF medications are covered under Part B)
To see the full list of services covered under Medicare Part B, visit Medicare.gov.
To receive Medicare Part B, you are required to pay a monthly insurance premium. Most people pay the standard premium amount ($135.50 per month in 2019) if you sign up for Part
B when you are first eligible, which is automatically deducted from your Social Security check each month.
Out-of-pocket costs for Medicare Part B services vary. Generally, you will pay a deductible annually ($185 in 2019 and then 20 percent of the Medicare-approved amount for covered services, if you use providers who accept Medicare assignment. The Medicare
Part B deductible and coinsurance do not apply to some screening and preventive services.
Medicare Advantage Plan (Part C)
Medicare Part C, also known as Medicare Advantage, is provided by Medicare-approved private insurance companies. Medicare Advantage plans:
- Include all benefits and services covered under Medicare Parts A and B
- Usually include Medicare Part D -- or Medicare prescription drug coverage
- May include additional benefits and services, such as dental, vision, hearing, and wellness programs, at an extra cost
While Medicare Advantage Plans are required to follow Medicare guidelines, the amount paid for deductibles, copayments, and/or coinsurance varies by plan. Medicare Advantage plans have an out-of-pocket maximum for Parts A and B. These plans usually have
network restrictions, limiting which doctors and hospitals you can use. These rules can change each year, and the Medicare Advantage plan must notify the enrollee about any changes before the start of the next enrollment year.
Medicare Part D (Medicare Prescription Drug Plan)
Medicare Part D, or the Medicare Prescription Drug Plan, is an optional benefit administered by Medicare-approved private insurance companies to help cover prescription drug costs. Those who wish to add Part D coverage to Medicare Parts A or B are usually
required to pay a monthly premium, which varies by the plan, household income, and the geographical area (zip code and state) of residence. Medicare Advantage Plans include Part D.
Medicare Extra Help
Medicare Extra Help is offered through the Social Security Administration to help people with limited income and resources with costs related to a Medicare prescription
drug plan. You are automatically eligible for Medicare Extra Help if you:
- Are eligible to receive both Medicare and Medicaid (referred to as full dual eligibility)
- Have a Medicare Savings Program that assists with Medicare premiums and cost-sharing
- Receive need-based Supplemental Security Income (SSI) benefits but not Medicaid.
Medicare Supplemental Plans (Medigap)
Medigap is insurance to cover Medicare deductibles and coinsurance. Medigap plans are offered by Medicare-approved private insurance companies and have several requirements:
- You must have Original Medicare Part A and Part B
- You cannot have a Medicare Advantage and a Medigap plan at the same time
- You must pay a separate premium for a Medigap plan, in addition to your monthly Part B and Part D premium
Medigap plans cover only one person. Your spouse must have a separate individual policy.
Because there is no annual enrollment period for these plans, you can drop your supplement at any time.
Medigap plans strictly follow Medicare guidelines, which means they will cover your Medicare costs for Medicare Part A- and B-covered services only. These plans pay after Medicare pays.
Some things to remember:
- If you already have a Medicare Advantage Plan (Part C), you will not be able to purchase a Medigap plan unless you switch back to Original Medicare.
- Medigap plans do not include prescription drug coverage, so you’ll want to purchase a stand-alone Part D drug plan to cover your medications.
- Medigap plans are available in all 50 states. To purchase a Medigap plan, you can go to any insurance company or a broker that is licensed to sell one in your state. In some states, Medigap policies may not be available to individuals younger than
65, so if you have Medicare due to disability, you may or may not be able to purchase a Medigap plan.
Medigap plans are identified by letters A-N. Medigap Plan F is currently the plan with the highest level of coverage. It pays for all Medicare costs for covered services. Medigap Plan F is also offered as a high-deductible plan by some insurance companies
in some states. If you choose the high-deductible option, it means you must pay for Medicare costs up to the deductible amount before your policy will pay anything.
Comparing Medicare Options
To look for specific Medicare Advantage plans or Medicare prescription drug plans available in your area, visit the Medicare Plan Finder. For more information about Medicare, download
the Medicare & You official handbook.
A Cystic Fibrosis Foundation Compass case manager can also help you find a plan that best suits your medical needs. Connect with Compass today at 844-COMPASS (844-266-7277), Monday through Friday, 9 a.m. until 7 p.m. ET, or email compass@cff.org.