Medicare is a federal health insurance program that offers coverage for hospitalization and medical care services, divided into four sections (A-D). Part A covers hospital stays, home health services and some skilled nursing facility care while Part B includes outpatient services like doctor visits and durable medical equipment.
What is Medicare?
Medicare is a federal health care program that helps cover some of your medical costs. You can sign up for Original Medicare (Parts A and B), or sign up for one of many Medicare Advantage plans available today.
Medicare Advantage Plans combine Parts A, B and often Part D into one plan offered by private companies approved by Medicare that abide by its rules.
Most Medicare Advantage Plans require you to use only doctors, hospitals and pharmacies within their network or else you will pay extra. They may also limit annual out-of-pocket spending. Under the Affordable Care Act there may also be premium tax credits or cost sharing reductions available that will help to bring costs down further.
Who is Medicare for?
Medicare coverage extends to individuals 65 or older as well as some younger individuals living with disabilities, end-stage renal disease or amyotrophic lateral sclerosis (ALS, Lou Gehrig’s Disease).
Some beneficiaries opt to enroll in private Medicare Advantage health plans through private insurers; these plans are funded by payroll taxes and general revenues from the federal government as well as premiums paid by beneficiaries themselves.
Beneficiaries have the option to supplement their coverage through Medicare Part D, which covers prescription drugs. This program is funded through premiums paid by beneficiaries as well as general revenue collected from the federal government; plus there may be deductibles and co-pays to pay depending on which plan beneficiaries select.
What is Medicare Part A?
Medicare Part A (hospital coverage) is provided free if both you and your spouse worked and contributed Medicare taxes for 40 quarters, providing inpatient hospital stays, skilled nursing facility care, hospice services and in-home hospice services.
Medicare Part B (medical insurance) is the other component of Original Medicare, covering doctor visits, medical equipment and supplies as well as preventive services like flu shots. A monthly premium must be paid through Social Security withholdings.
Individuals incarcerated due to arrest can still register with Medicare Part B or premium Part A during a Special Enrollment Period (SEP), opting to have coverage start retroactively up to six months post-arrest release date.
What is Medicare Part B?
Part B provides funding for medical services like visits to doctors, outpatient care and durable medical equipment, as well as preventive services like screenings, lab tests and vaccinations.
Part B requires a monthly premium payment that is usually withheld from Social Security checks. Individuals earning above a certain threshold may pay additional premiums.
People transitioning off an employer group health plan may qualify for Medicare Part B during a Special Enrollment Period without incurring a fee, typically eight months post-group coverage termination. Anyone missing their SEP could need to wait for another opportunity and could incur late enrollment penalties.
What is Medicare Part C?
Medicare Part C, also referred to as Medicare Advantage plans, are specialized private health insurance plans designed to provide more comprehensive healthcare coverage than Medicare Original. These plans typically offer prescription drug coverage and may offer other advantages like non-emergency medical transport or home health services.
There are various Medicare Advantage plans available, each offering different premiums, deductibles, copays and coinsurance amounts. Some require you to use only providers within their network while others offer more freedom by giving you more choices from a wider list of providers.
Most individuals can enroll in Medicare Advantage during their Initial Enrollment Period, which covers seven months either side of when they turn 65, as well as during an annual open enrollment period.
What is Medicare Part D?
Medicare Part D (Medigap D in the US) is a United States federal program designed to provide prescription drug coverage. It offers a defined standard benefit which consists of deductible, initial coverage phase and gap coverage; plus various utilization management tools like prior authorization, quantity limits and step therapy plans as well as formularies (list of covered drugs).
Employers and unions that offer retiree drug coverage that is comparable to Medicare Part D may qualify for federal grants to help cover the costs of their plan.
Individuals have one Special Election Period each year in which to update or switch their PDP or MA-PD policy, giving beneficiaries an opportunity to select any plan that fits both their needs and budget.
