Learn more about Medicare Basics
Medicare is the federal health insurance program that covers most people age 65 and older. People who are under the age of 65 that are disabled or have End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant) are also eligible for coverage.
People covered by Medicare are called beneficiaries. Medicare pays for much of their health care, but not all of it. Medicare covers most acute medical conditions (conditions from which a patient usually recovers).
Medicare does not cover:
- Most care given at home
- Most care given in assisted living facilities
- Most care given in nursing homes
- Care for people with chronic disabilities and lengthy illnesses
- For many people, there are large gaps in Medicare's prescription drug plans
Medicare benefits are provided in 4 parts – A, B, C and D:
Medicare Part A: Hospital Insurance - Most people don't pay a premium for Part A because they or a spouse already paid for it through their payroll taxes while working. Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits.
Medicare Part B: Medical Insurance - Most people pay a monthly premium for Part B ($115.40 per month in 2011); if your income is above $85,000 (single) or $170,000 (married couple), then your Medicare Part B premium may be higher than $116.50 per month). Medicare Part B (Medical Insurance) helps cover doctors' services and outpatient care. It also covers some other medical services that Part A doesn't cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.
Medicare Part C: Medicare Advantage that consolidates parts A, B, and D into a single plan run by private insurance carrier - Various HMOs, PPOs and similar health care organizations can offer health insurance plans to Medicare beneficiaries. At a minimum, they must provide the same benefits that the Original Medicare Plan provides under Parts A and B. Part C organizations are also permitted to offer additional benefits such as dental and vision care. But, to control costs, Part C plans are allowed to limit a patient's choice of doctors, hospitals, etc., to just those who are members of their networks. This can be a major disadvantage if a patient's favorite doctor or hospital is not a member of their networks.
Medicare Part D: Prescription Drug Coverage - Most people will pay a monthly premium for this coverage. Starting January 1, 2006, new Medicare prescription drug coverage was made available to everyone with Medicare. Everyone with Medicare can get this coverage that may help lower prescription drug costs and help protect against higher costs in the future. Medicare Prescription Drug Coverage is insurance. Private companies provide the coverage. Beneficiaries choose the drug plan and pay a monthly premium. Like other insurance, if a beneficiary decides not to enroll in a drug plan when they are first eligible, they may pay a penalty if they choose to join later.
What is Medigap?
Medigap or a Medicare supplement plan is privately run and covers many of the costs not paid by Medicare. It is not available to those that receive Medicaid coverage.
Plan Basics
- Plans that provide medical insurance in addition to Medicare (e.g. fills the gaps in Medicare)
- Pays the Medicare A and B deductibles and coinsurance (your 20%)
- Private sector offered and administered
- Federally standardized plan designs
- 10 standardized plans (A,B,C,D,F,G,K,L,M,N)
- The plans are the same through all carriers, it doesn’t matter who sells it to you.
- Does not include prescription drug coverage
- You “must” enroll in a Part D plan