The A, B, Cs and D of Medicare

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Choosing the right Medicare plan, whether for yourself or someone you love, can be a lot like going back to school. Your reading comprehension skills will be tested ("The transfer enrollment period begins the month after the month you leave the plan or the plan coverage ends," huh?). You'll have to theorize (in 2010, I will make 4 visits to my physician, spend 2 days in the hospital, land in the ER once and be prescribed 3 drugs, 2 of them generic). With that info you can then determine the x factors in the Medicare equation: Premium + out of pocket costs (deductible + co-payments + coinsurance) = Total Health Care Cost. Then it's on to the multiple choice: (The Medicare plan that most closely fits your needs is: a) Part A; b) Parts A and B; c) Part C; d) Parts A, B and D; e) none of the above. After comparing and contrasting the available options, you enroll in a plan. You have all of 2010 to grade yourself.

To give you a headstart on your enrollment homework, we've put together a primer that explains the A, B, C and Ds of Medicare.

Government Run

Original Medicare is a fee-for-service plan managed by the Federal Government, and includes hospital and medical insurance:

Part A -- Hospital Insurance: Covers inpatient care, some short-term stays at skilled nursing facilities, home health and hospice care. While there is no premium with Part A, (for most Medicare recipients), there's a deductible for hospital stays (in 2010, it's $1100), fees for most services, and no cap on out-of-pocket expenses.

Part B - Medical Insurance: Generally covers 80 percent of the cost of doctors' services, outpatient diagnostic tests and therapy, as well as preventative care such as flu shots, Pap tests, mammograms and screenings for prostate cancer, cardiovascular disease and diabetes. Part B also picks up the tab for medical equipment such as wheelchairs and walkers (again, the patient is responsible for the 20 percent coinsurance). While most Medicare beneficiaries will continue paying the 2009 monthly premium of $96.40, in 2010, new enrollees whose gross adjusted income is less then $85,000 ($170,000 per couple), will pay $110 a month for Part B.

Managed by Private Insurers

Medigap Policies: These plans are sold by private insurance companies to supplement Original Medicare coverage. Except in Massachusetts, Minnesota, and Wisconsin, there are up to 12 standardized Medigap policies labeled Medigap Plan A through Plan L.

Part C-- Medicare Advantage Plans (MA): Medicare Advantage offers the benefits of Medicare A and B  and often include prescription drug coverage (Part D). These private health plans may also offer additional benefits that are not covered by Medicare, such as vision, hearing, dental, and/or health and wellness programs. Costs and services vary by plan.

Part D - Prescription Drug Insurance: Part D is offered through private plans approved by Medicare. Deductibles, premiums, co-pays as well as which drugs are covered vary greatly among plans. Extra help for people on Medicare with limited income and resources is available and can reduce or eliminate premiums, deductibles, and co-pays.

For More Information: The official government site, www.medicare.com is filled with information, tools and downloads aimed at educating consumers. You can also learn more about your coverage options and calculate which prescription drug plan is right for you, by logging on to the CVS Pharmacy website.