What is Medicare?

Victoria Burke by Victoria Burke | Licensed since 2011
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This article was updated on: 08/29/2018

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The federal government defines Medicare as a federal health insurance program designed for those age 65 and older. Since its inception in 1965, Medicare has expanded to provide coverage for some younger people with disabilities, and for people with end-stage renal disease and Amyotrophic Lateral Sclerosis (ALS). If you will soon be eligible for Medicare, you may be wondering how (or whether) Medicare coverage will fit your individual insurance needs. Understanding the basics of Medicare is fairly simple when you recognize the four main “parts” of Medicare insurance: Part A, Part B, Part C, and Part D.

What is Medicare Part A?

Medicare defines Part A as coverage for inpatient care you receive in Medicare-approved facilities such as (but not limited to) hospitals and skilled nursing facilities. Medicare Part A also typically covers hospice care and limited home health care.

What is Medicare Part B?

Medicare defines Part B as medical insurance that generally covers doctor visits, medically necessary outpatient services, preventive care, and certain outpatient diagnostic tests and labs. Medicare Part B also typically covers outpatient mental health care and durable medical equipment and supplies. Most people have to pay a monthly premium to receive Part B coverage.

What is Medicare Part C?

Medicare defines Medicare Advantage (Medicare Part C) as another way you can receive your Medicare Part A and Part B coverage. Medicare-approved private insurance companies offer Medicare Advantage plans. You are eligible to enroll in a Medicare Advantage plan if you have Medicare Part A and you are eligible for Part B.

Medicare Advantage plans must provide at least the same level of insurance coverage as Medicare Part A and Part B provide—with one exception:  hospice care is still covered under Medicare Part A. Most Medicare Advantage plans offer additional benefits not available under Medicare Part A and Part B, such as prescription drug coverage, routine hearing, routine dental, and routine vision coverage.

Medicare Advantage plans usually have local or regional service areas. If you are interested in enrolling in a Medicare Advantage plan, you must select one that operates where you live. This is because some Medicare Advantage plans have contracted networks of doctor, hospitals, and other healthcare providers who deliver the services covered by the plan.

Your Medicare Advantage plan premium may be as low as $0.00, depending upon the insurance company offering the plan and the amount of coverage it provides. You continue to pay your Medicare Part B premium.

What is Medicare Part D?

Medicare defines the Part D program’s goal: to make prescription drug coverage available to beneficiaries.  You can sign up for a stand-alone Medicare Part D Prescription Drug Plan to work alongside your Medicare Part A and/or Part B coverage. Or you can get all your Medicare coverage through a Medicare Advantage Prescription Drug plan. Most people pay a separate premium to the insurer for their Medicare Part D prescription drug coverage.

Every Medicare Prescription Drug Plan has a formulary or list of prescription drugs it covers. Typically the formulary includes generic and brand medications. Usually the cost-share (the copayment or coinsurance amount you pay) is lower for generic medications than for brand name prescription drugs. If you enroll in a stand-alone Medicare Prescription Drug Plan or a Medicare Advantage Prescription Drug plan, make sure you choose a plan that covers your medications. Many plans make their formularies available online. A plan’s formulary may change at any time. You will receive notice from your plan when necessary.

What is Medicare Supplement insurance?

If you decide to stay with Medicare Part A and Part B, you may be interested in buying a Medicare Supplement (Medigap) plan. Private insurance companies offer standardized Medicare Supplement plans. These plans are designed to work alongside Medicare to help pay for some of Medicare’s out-of-pocket costs, such as coinsurance, copayments, and deductibles. Premiums vary by insurance company, coverage selection, and when you apply for Medicare Supplement insurance.

If you have questions about Medicare and your coverage options, I would be happy to answer them. You can use the links below to reach me. If you wish to learn more about some of the Medicare plans where you live, use the Compare Plans button on this page.

Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the Federal Medicare program.

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