What is Medicare
Medicare is federal health insurance managed by the Centers for Medicare & Medicaid Services. It is for people 65 or older, some younger people with disabilities, and people with End-Stage Renal Disease. It is defined in four parts: Hospitalization (Part A), Medical Services (Part B), Medicare Advantage (Part C), and Prescription Drug Plans (Part D).
When most people turn 65, they’re eligible for Original Medicare, which is a fee-for-service, federally managed health plan that provides eligible individuals with coverage for and access to doctors, hospitals and other healthcare providers that accept Medicare. (Note: fee-for-service is a form of health insurance whereby health care providers are reimbursed based upon a fee for each service they provide to the insured individual.)
Hospital and medical insurance
Original Medicare includes two parts: Part A (Hospital Insurance), which covers services like skilled nursing facility or inpatient hospital care, and Part B (Medical Insurance), which helps pay for services for doctors/other healthcare providers, outpatient care, or durable medical equipment. While most people are automatically enrolled in Medicare Part A, each person must sign-up for Part B.
Pays for services received if you stay in a hospital to receive care.
- Inpatient hospital services and care
- Skilled nursing facilities care
- Hospice care
- Home care services (following an acute stay)
Pays for doctor’s services.
- Doctor’s visits
- Outpatient services, surgeries, physical, speech and occupational therapy
- Ambulance services
- Home care services (not following acute stay)
- Medical and lab tests
- Durable medical equipment and supplies
- Preventative care, mammography, Pap tests
Part C: Medicare Advantage Plans
Part C is Medicare Advantage Plans. They provide all the benefits of Part A and Part B plus additional benefits like vision, hearing, dental, and wellness programs. Most plans include coverage for Prescription Drugs (Part D). These are known as Medicare Advantage-Prescription Drug (MA-PD) Plans. Only Medicare-approved private companies can offer these plans.
Part D: Prescription Drug Plans
Medicare Part D provides standalone coverage for your prescriptions. You have the choice to have this standalone coverage, which works well with a Medicare Supplement plan, or combine it in a Medicare Advantage-Prescription Drug (MA-PD) Plan. Either choice helps you cover the costs of your prescription drugs.
Medicare Supplement plans
If eligible, you can get health coverage through Original Medicare, but it does not pay for everything. A Medicare Supplement plan, also known as Medigap, can help you pay for additional services and benefits including some copayments, coinsurance, and deductibles.
You become eligible for Medicare when you turn 65. You have a window to sign up for Medicare. It begins 3 months before you turn 65 and ends 3 months after you turn 65. Younger individuals who have a disability or End-Stage Renal Disease may also be eligible.
What does Medicare cost?
In general, there is a monthly premium for Medicare coverage and fees for care received. There are various out-of-pocket costs associated with Medicare Parts A, B, C, and D. It’s important to understand the costs so you can select a plan that is best suited for you.
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Page last updated date 10/27/2023