Seize it all: A Cowboys coach’s catchphrase fits Medicare

The federal program is designed to give people age 65 and older a basic level of health coverage.

(Sponsored) Every fall brings cooler weather, changing leaves, football and Medicare open enrollment.

You might think this column would focus on football.

Not this time — it’s the ABCs of Medicare and open enrollment.

Medicare is a federal program meant to provide basic healthcare coverage for people age 65 and older. It is available to U.S. citizens and to people who have been lawful U.S. residents for at least five years.

Here is a closer look at how it works.

Medicare has four parts: A, B, C and D.

Part A covers hospital care. It pays for inpatient hospital services and other inpatient care provided in institutions.

Part B covers doctors and outpatient services. It helps pay for physicians’ services, durable medical equipment, outpatient therapy, diagnostic X-rays and laboratory tests. A premium is required for Part B.

Parts A and B are known as original Medicare. If you choose to receive Social Security at age 65, you are automatically enrolled in both parts. If you do not want Part B, you must actively opt out. If you delay Social Security, you can still receive Medicare Parts A and B, but you must file an application for benefits when you turn 65.

Even so, Parts A and B do not cover all medical expenses. To fill the gaps, the government allows people to buy private supplemental insurance known as Medigap. The standardized plan benefits are set by Medicare.

Original Medicare is accepted by nearly all providers.

Because original Medicare is expensive for the federal government, Part C and Part D were added in 2003 and are handled through private for-profit insurance companies.

Part D provides prescription drug coverage and requires a separate policy through a private insurer.

Part C consists of Medicare Advantage plans. These plans replace original Medicare and sometimes Part D as well. With an Advantage plan, original Medicare is replaced by a private for-profit insurance company.

Why choose that? Marketing plays a big role.

Advantage plans are often sold with extra benefits such as dental or vision care. They come in several forms, including HMO, HMO point of service, PPO, private fee for service, special needs plans and medical savings account plans. Most Advantage plans either include drug coverage or require enrollment in Part D through an affiliated company. Most also require you to use in-network providers or pay more for out-of-network care.

During open enrollment, you can switch from original Medicare to an Advantage plan, move from an Advantage plan back to original Medicare, and join, switch or drop Part D. If you want Medigap coverage after leaving an Advantage plan, you may need to medically qualify for it.

Want to move from one Advantage plan to another? That change can be made between Jan. 1 and March 31 each year.

This is only a broad overview; the law includes many more provisions. If it all seems confusing, consider working with a Medicare consultant to find the plan that best fits your needs.

Most important of all, do not let this federal health insurance benefit pass you by. As former Cowboys coach Mike McCarthy said: “Carpe omnia!”