What is Medicare?

What Is Medicare?

Sep 9, 2016 |

We’ve all heard about Medicare. Thanks to our federal health insurance program, retirees (65 years and older) have the option of convenient healthcare at a comfortable price for any fixed income.

Medicare also helps certain individuals with qualifying health conditions. All of us will most likely use Medicare services once we become eligible. So you must be wondering: “What is Medicare? How does it work? How will it work for me?”.

Not to worry. We’ve got the Medicare basics for you, right here.

What is Medicare?

Like we mentioned before, Medicare is a type of health insurance plan provided by the federal government. However, it’s only available to:

  • Senior citizens 65 years of age and older.
  • Adults with certain approved medical conditions, such as:
  • Qualifying permanent disabilities.
    • End-Stage Renal disease.
    • Lou Gehrig’s disease.

How does Medicare work?

Medicare is an entitlement program, which means most American citizens earn the right to enroll by paying taxes and working for a required period of time. If you don’t meet the minimum required time, Medicare is flexible. You can still enroll and receive benefits, although you may have to pay more.

What’s included under Medicare?

Medicare has four parts that cover specific services: hospital insurance (Part A), medical insurance (Part B), Medicare Advantage Plans (Part C), and prescription drug coverage (Part D). You can read more on each part below.

How do you get Medicare?

When it comes to receiving Medicare benefits, you can go one of three ways:

  • Original Medicare: Part A and Part B coverage via a fee-for-service program provided directly through the government. Part D is usually bought in addition to Original Medicare. Most hospitals and doctors across the U.S. will accept Original Medicare.
  • Medicare Supplement Plan (Medigap Policy): People buy these plans to use with Original Medicare and Part D. These are bought from private Medicare-approved insurance companies and are used to supplement the coverage “gaps” in Original Medicare. Medigap policies offer the benefit of a large, unrestricted provider network and out-of-country care.
  • Medicare Advantage Plan: Some opt to get their Medicare benefits from a private Medicare-approved insurance company instead. Medicare Advantage Plans often provide more coverage (vision, dental, etc.) than just Original Medicare.

What is Medicare Part A?

Medicare Part A refers to hospital insurance. This covers possible inpatient hospital services, including:

  • Hospital stay and care
  • Nursing facility care
  • Hospice care
  • Some home health care

What is Medicare Part B?

Medicare Part B refers to medical insurance. Part B helps cover:

  • Services from doctors and other health care providers
  • Outpatient care
  • Home health care
  • Durable medical equipment
  • Many preventive services

What is Medicare Part C?

Part C Medicare is private health insurance, provided by a private company contracted with Medicare. Medicare Advantage Plan benefits consist of both Part A and Part B services, and most Medicare Advantage Plans also include coverage for prescription drugs.

Medicare Advantage Plans differ from Original Medicare in two ways:

  1. Original Medicare provides coverage for most all hospitals and doctors in the U.S., whereas Medicare Advantage Plans have network restrictions and provide more limited access to hospitals and doctors.
  2. Medicare Advantage Plans can also include vision or dental coverage, which are not offered under Original Medicare.

Part C Medicare Advantage Plans include:

  • Preferred Provider Organizations (Medicare PPO Plans)
  • Health Maintenance Organizations (Medicare HMO Plans)
  • Medical Savings Account Plans (MSA Plans)
  • Private Fee-for-Service Plans (PFFS Plans)
  • Special Needs Plans (SNP)

What is Medicare Part D?

Part D Medicare offers coverage for prescription drugs. Coverage under Part D comes from private companies and insurance companies that are Medicare-approved.

Depending on how you choose to get your Medicare services, you may or may not need Part D for prescription drug coverage. Some Medicare Advantage Plans (Part C) may offer coverage on prescription drugs that are not technically Part D coverage, but follow the same rules at these plans.

Your Medicare Coverage

No matter where your Medicare coverage comes from, what’s actually covered will be based on three main factors:

  1. State and federal laws.
  2. Medicare mandated decisions on national coverage (whether something is covered or not).
  3. Decisions on local coverage made by companies that process Medicare claims. While processing the claims, the company can decide if something is medically necessary or not.

You can ensure you’re always getting the healthcare you need with the provider you want by teaming up with one of our agents.

Are you aware of the benefits available to you? If you’re not sure, stop by our next Medicare 101 event.

Sep 9, 2016 | | 0 comments


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