Medicare 101
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- What is Medicare?
Medicare is a Federal health insurance program for people 65 years or older, certain people with disabilities, and people with permanent kidney failure treated with dialysis or a transplant. Medicare has two parts - Part A which is hospital insurance, and Part B which is medical insurance.
- How Does Medicare Work?
Medicare consists of different “Parts” that cover specific healthcare services. Depending on your current healthcare needs and anticipated needs, Medicare is easily buildable to create a program that is correct for you. There are two programs to begin with, then build off of – Original Medicare and Medicare Advantage. Most healthcare plans cover a certain limit of services and then begin to charge a co-insurance, deductible, or daily rate depending on the situation.
- Eligibility
Medicare is usually for people 65 or older, but they could be eligible earlier if they have a disability, End- Stage Renal Disease (ESRD), or ALS
- Cost
Medicare costs vary based on income and insurance choices. Most people receive Part A at no cost, but Part B has a monthly premium.
- Will I automatically be enrolled in Medicare once I turn 65?
If you are receiving Social Security or Railroad Retirement or disability benefits, you will be automatically enrolled in Medicare Part A and Part B. About 3 months prior to your 65th birthday or 24th month of disability, you will be sent an Initial Enrollment Package that will contain information about Medicare, a questionnaire and your red, white and blue Medicare card.
- Who is eligible for Medicare Part A (hospital insurance)?
If you have worked at least 10 years in Medicare covered employment you will qualify for premium free Medicare Part A (Hospital Insurance). To qualify, you must be:
• 65 or older; or
• Disabled and receiving disability benefits from Social Security or the Railroad Retirement Board for 24 months; or
• Have permanent kidney failure treated with dialysis or a transplant
- What types of services are covered under Medicare Part A?
In general, Medicare Part A covers inpatient care in hospitals, skilled nursing facility care, hospice care, medically necessary inpatient rehabilitation, acute care rehabilitation, and home health care.
- What types of services are covered under Medicare Part B?
Medicare Part B helps pay for doctors' services, outpatient hospital care, blood, medical equipment and some home health services. It also pays for other medical services such as lab tests and physical and occupational therapy. Some preventive services such as mammograms and flu shots are also covered. Medicare Part B does NOT cover routine physical exams; eye glasses; custodial care; dental care; dentures; routine foot care; hearing aids; orthopedic shoes; or cosmetic surgery. It also does not cover most prescription drugs or health care you get while traveling outside the United States (except under limited circumstances).
- What Is Medicare Part C?
These are your various Medicare Advantage Plans that are offered by private carriers, ex: Humana, United Healthcare, Cigna, Aetna etc.
- What is Part D?
These are your Prescription Drug Coverages. While some prescriptions are covered as a part of Medicare A, Medicare Part D helps to cover the cost of prescription drugs. This may help individuals lower their drug costs and help protect against higher costs in the future. All plans within Medicare cover a wide range of prescription drugs that people take, including most drugs in certain protected classes (for cancer or HIV/AIDS treatment).
- What is a Medicare deductible?
A deductible is the amount you must pay each year before Medicare begins paying its portion of your medical bill. There are deductibles for both the Part A (Hospital Insurance) and Part B (doctor services) portions of Medicare. Your deductible is taken out of your claims when Medicare receives them. Medicare will not start paying on your claims until you have met your annual deductible. If you have any questions on the status of your deductible please contact your Medicare carrier.
- How do Medicare managed care plans work?
Medicare managed care plans are another way for you to receive Medicare benefits. All plans must provide all of the services that you would receive under Original Medicare with some added benefits. You usually must use the doctors, hospitals and providers in the plan's network. You may have to pay a monthly premium to your health plan. However, you would not need a supplemental Medigap policy if you join a managed care plan.
- What Is Medigap?
Medicare Supplement Insurance, commonly known as Medigap, helps cover some of your Medicare costs. The plans are sold by private insurance ...