Medicare Program Overview
Medicare is the federal health insurance program:
- people age 65 or older,
- people under age 65 with certain disabilities, and
- people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant) and amyotrophic lateral sclerosis (Lou Gehrig’s disease).
Medicare consists of the following:
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 covers.
- In Patient Hospital Care
- Skilled Nursing Facility Care
- Nursing Home Care (as long as custodial care isn't the only care you need)
- Home Health Services
- In Patient Mental Health
Beneficiaries must meet certain conditions to get these benefits.
Part B Medical Insurance
Most people pay a monthly premium for Part B. 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.
- Preventive Services
- Physical, Occupational and Speech therapists
- Cardiac and Pulmonary Rehabilitation
- some home health care
- Ambulance services
- Durable Medical Equipment
- Clinical Diagnostic, laboratory and non-laboratory tests
- Outpatient Mental Health Care
- Getting a second opinion before surgery
- Limited outpatient prescription drugs
Part B helps pay for these covered services and supplies when they are medically necessary. If you don't sign up for Part B when you're first eligible for Medicare, you'll have to pay a late enrollment penalty.
Medicare Part C (Medicare Advantage Plans)
A type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan and aren’t paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.
Prescription Drug Coverage Part D
Prescription Drug Coverage is insurance provided private companies. Most people will pay a Premium, Co-payments or Coinsurance, Cost in the Coverage Gap, for this coverage. Starting January 1, 2006, new Medicare prescription drug coverage became available to everyone with Medicare. Everyone with Medicare receives this coverage that may help lower prescription drug costs. 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.
If you have limited income and resources, your state may help you pay for Part A, and/or Part B. You may also qualify for Extra Help to pay for your Medicare prescription drug coverage.
For more information visit www.medicare.gov
Note: Information for this article provided by www.cms.gov