What is Medicare?
Medicare is a federally-facilitated health insurance program for people over 65 who are receiving benefits from the Social Security Administration or the Railroad Retirement Board (RRB), people under 65 who are receiving Social Security Disability Insurance
(SSDI), or people receiving certain disability benefits from the RRB.
Medicare is an important coverage option for people with cystic fibrosis, especially adults with the disease who are receiving SSDI. 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.
For more information about Medicare and disability, visit Medicare.gov.
Medicare offers five primary plan choices:
- Original Medicare Part A
- Original Medicare Part B
- Medicare Advantage Plan (also known as Part C)
- Medicare Prescription Drug Plan (also known as Part D)
- Medicare Supplemental Plan (Medigap)
By learning how each of these parts work and what services they cover, you can ultimately understand how to choose the right Medicare plan for you.
Medicare Part A
The first component of Original Medicare, known as Medicare Part A, focuses on inpatient care. 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.
Each type of care may come with its own set of out-of-pocket expenses, such as
copayments or a
deductible. To understand more about the specific costs involved in Medicare Part A, call Cystic Fibrosis Foundation
Compass at 844-COMPASS (844-266-7277), Monday through Friday, 9 a.m. until 7 p.m. ET, or email
compass@cff.org.
Medicare Part B
Medicare Part B, or the second component of Original Medicare, focuses on medical services provided outside of hospitals and medical facilities. This includes doctors' visits, outpatient services, some preventative care, and other medically necessary
services. Medicare Part B typically covers:
- Services from doctors and other health care providers
- Outpatient care
- Diagnostic tests (X-rays, blood work) and imaging (CT, PET scans, MRIs)
- Home health care (when homebound)
- Durable medical equipment
- Some preventive services
- Ambulance services
- Emergency room 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. This means that you must pay a certain amount of money each month in order to get and maintain Part B medical insurance coverage. Most people pay the standard premium
amount ($134 per month in 2017), which is automatically deducted from their Social Security check each month.
Medicare also requires you to meet an annual deductible. Until this pre-determined amount ($183 in 2017) is satisfied, Part B will not begin to pay a percentage of any medical
insurance-related costs. Once you have met the deductible, you will then generally be responsible for 20 percent of the bill, while Part B will pay 80 percent of the Medicare-approved amount for the covered service. However, the deductible does not
apply to all services, so you may want to discuss the exact benefits and financial implications of this with a CF Foundation Compass case manager.
Medicare Advantage Plan (Part C)
Medicare Part C, also known as Medicare Advantage Plan, is provided by Medicare-approved private companies. Medicare Advantage Plans combine all benefits and services listed under Parts A and B, and usually include Part D (prescription drug coverage).
Plans may also include additional benefits and services such as dental, vision, hearing, and wellness programs.
Although Medicare Advantage Plans are required to follow Medicare guidelines, insurance companies can charge different out-of-pocket costs or have their own rules for how services are provided, such as an
out-of-pocket maximum, a referral requirement to see a specialist, or a limited
provider network. These rules can change each year. The plan must notify the enrollee about any changes before the start of the next enrollment year. For
this reason, it is important to find out how each Medicare Advantage plan works by
conducting a benefits assessment each year or talking to a CF Foundation Compass case manager.
To learn more about Medicare Advantage Plans, including some of the reasons why Medicare Part C might be a good option for you, check out the following resources:
Medicare Part D
Medicare Part D, or the Medicare Prescription Drug Plan (PDP), is administered by Medicare-approved private insurance companies to help cover the cost of prescription medications. Medicare Part D is an optional benefit. Those who wish to add Part D coverage
to Medicare Parts A and/or B are usually required to pay a monthly insurance premium, which will vary by plan, income, insurance provider, and state. However, most Medicare Advantage Plans include Part D.
Medicare Extra Help
Medicare Extra Help is a program offered through the Social Security Administration that helps with prescription drug costs through Medicare Part D. To qualify for
Extra Help, you must have an income under 150 percent of the federal poverty level (FPL), meet the resource limit, and live in the United States. Medicare Extra Help is not available in Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana
Islands, or American Samoa.
If you have not already enrolled in a Medicare Drug Plan (Part D), you must join one to use Medicare Extra Help. If you do not select a Part D plan, Medicare may automatically enroll you in a plan that may or may not cover all your medications.
In addition, some people will automatically qualify for Medicare Extra Help if they have Medicare and they:
- Qualify for full or partial dual eligibility, or
- Receive need-based Supplemental Security Income (SSI) benefits
If you qualify for Medicare Extra Help and join a Medicare drug plan, you may:
- Get help paying for a Medicare drug plan’s costs
- Have no coverage gap
- Have no late enrollment penalty
- Have the chance to switch plans at any time (Any change will take effect the first day of the following month)
* For Alaska and Hawaii, see
the U.S. Federal Poverty Guidelines, U.S. Department of Health & Human Services.
Medicare Supplemental Plans (Medigap)
If you are insured under Medicare Part A and Part B, you are always expected to share the cost for health care services such as copayments, coinsurance, and deductibles. Because Medicare Parts A and B do not cover all services in full, Medicare Supplement
Insurance (Medigap) policies are available to help you pay for some of these costs. Medigap plans, which are offered by Medicare-approved private insurance companies, require that you already have Part A and Part B to enroll, and pay a separate premium
in addition to your monthly Part B and Part D premium. You will need to purchase a separate Part D plan to cover prescription charges, as the Medigap plans that became effective after June 1, 2010, no longer include prescription coverage.
Medigap plans will follow Medicare guidelines, which means they will not cover the charges that are not covered by Medicare Part A or Part B, nor prescription charges covered through Part D. If you already have a Medicare Advantage Plan (Part C), you
will not be able to purchase a Medigap plan unless you are switching back to Original Medicare.
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, however, Medigap policies may not be available to individuals under 65 years of age.
To learn more about Medigap plans, visit Medicare.gov.
The chart below shows basic information about the different benefits that Medigap plans cover.
Comparing Medicare Options
The chart below shows two main options for how you get your Medicare coverage.