Information courtesy of the Medicare Plans Resource Center
Many of us find signing up for health insurance to be needlessly complicated, confusing, and stressful. Unfortunately, when it comes to signing up for Medicare while considering a specific healthcare issue such as essential tremor (ET), things aren’t much simpler.
Medicare is a health insurance program provided by the federal government for qualifying individuals, including people over the age of 65, those with certain disabilities, and individuals with end-stage kidney disease. Choosing the best option to meet your medical and financial needs can be challenging as there are a number of options to evaluate, especially when you are looking specifically for ET treatment.
In this piece, we outline the different parts of Medicare to help you understand your options and choose the plan that will work best for you.
Original Medicare (Medicare Part A and Part B): Original Medicare is a combination of Medicare Part A and Medicare Part B. After you pay a deductible, Medicare pays its share of the Medicare-approved amount, and you pay your share (coinsurance and deductibles).
Original Medicare coverage covers many aspects of ET treatment, however, some things still fall outside of the core Original Medicare coverage, which is why supplement and alternative plans exist.
Medicare Part A (Hospital Insurance): Medicare Part A covers inpatient hospital stays. You generally don’t have to pay a monthly premium if you or your spouse paid qualifying Medicare taxes while working. If you do need to pay, the amount will be based on how long you paid Medicare taxes.
This part of Medicare covers hospitalization, which will include most expenses involved in a hospital stay for deep brain simulations (DBS), a common surgical treatment for ET patients.
Medicare Part B (Medicare Insurance): Medicare Part B covers certain medical services, outpatient care, medical supplies, and preventive services. In general, Medicare enrollees pay a standard premium for part B. Those who reported income over a certain amount from 2 years prior, will have to cover an additional charge known as an Income Related Monthly Adjustment Amount (IRMAA).
Under part B, ET patients will receive coverage for specialist visits, physical therapy, qualifying medical equipment, preventative care, testing and more.
Medigap Insurance: Medigap insurance, which is commonly known as Medicare Supplemental Insurance, is a type of supplemental insurance used to cover health care costs that Original Medicare does not. You can purchase Medigap insurance if you are enrolled in Original Medicare. However, it cannot be used with a Medicare Advantage Plan.
If some of your physicians or the specialty ET treatments you receive fall outside of Original Medicare coverage, Medigap coverage may offer what you need. Talk to potential Medigap insurance providers and your healthcare providers to find options that work for you.
Medicare Part C (Medicare Advantage): Medicare Advantage Plans are an alternative to Original Medicare. They are offered by private insurance companies, which are approved by Medicare. Medicare Part C covers everything that Parts A and Part B do, but some plans offer additional coverage for dental, vision, and even fitness memberships. Each plan has different out-of-pocket costs and rules for how you obtain services.
This is another option if you utilize ET treatments that fall outside of the coverage of Original Medicare. Again, speaking to your healthcare providers and the insurance companies will help you find the right coverage.
Medicare Part D (Prescription Drug Coverage): Medicare Part D helps make prescription drug costs more affordable. The cost of the plan varies depending on the plan you choose.
Medications used to treat ET will be covered under Medicare Part D. These plans are sold by private insurance companies. Medicare offers a plan finder tool to help you find a plan that will cover your ET medications.
For more information about the available Medicare plans, visit MedicarePlans.com, a resource hub designed to provide you with the information you need to make informed healthcare decisions.