Plans & Coverage Explained Simply
Assistance with health care has been a growing issue in the United States for years. Many individuals, especially seniors, find that they are unable to afford medical bills or insurance for coverage. This leaves them with some tough decisions. Too often, one must choose between good health and finances. There's no middle ground. The Medicare program was developed by the government to help those who are eligible with their overwhelming health care bills.
There is a lot of information to process when considering Medicare. Knowing what it is and how it works will help you choose the program that will best meet your individual needs. Use this helpful guide to get an understanding of the Medicare program and which plan can best benefit you.
What is Medicare?
Medicare is a government health insurance program administered by the Centers for Medicare & Medicaid Services (CMS). Medicare is the largest health insurance service in the country, with around 49 million Americans participating. To be eligible you must be a citizen of the United States and meet certain requirements. If you are not a citizen of the United States, you can contact the Social Security Administration office to learn if you would be eligible.
Can you answer yes to at least one of the following statements?
- I am 65 years of age or older.
- I am under 65, but I have certain disabilities.
- I have End-Stage Renal Disease (kidney failure that requires a transplant or dialysis).
If so, then you are likely to be eligible for Medicare benefits.
Benefits: A Brief Summary
Medicare is basically broken down into two main categories: the "Original Medicare Plan" and the "Medicare Advantage Plan." Each category is made up of four sub-categories: Part A, Part B, Part C and Part D.
The Original Medicare Plan
The Original Medicare Plan consists of Part A. You do have the option of adding Part B and D. You will automatically be enrolled in the Original Medicare Plan unless you specifically choose to join a Medicare Advantage Plan (Part C).
The federal government manages the Original Medicare Plan. It operates on a fee-for-service plan. Most people pay a deductible and then a co-pay or co-insurance.
Medicare Advantage Plan
The Advantage Plan or Plan C combines your Part A and B coverage, but is provided by private insurance companies. You have the option of adding Part D if coverage is not already included. Advantage Plans include HMO, PPO, private fee-for-service plans, and Medicare special needs plans.
Medicare Part A Overview
Part A is hospital insurance provided by Medicare. Most people do not pay a premium for this coverage. Part A covers inpatient care in skilled nursing facilities, critical access hospitals, and hospitals. Hospice and home health care are also covered by Part A.
Go To: Part A
Medicare Part B Overview
Part B is medical insurance to pay for medically necessary services and supplies provided by Medicare. Most people will have to pay a premium to receive this coverage. Part B covers outpatient care, doctor's services, physical or occupational therapists, and additional home health care.
Go To: Part B
Medicare Part C Overview (Medicare Advantage Plan)
Part C is the combination of Part A and Part B. The main difference in Part C is that it is provided through private insurance companies approved by Medicare. With this program, you may have lower costs and receive extra benefits.
Go To: Part C
Medicare Part D Overview
Part D is stand-alone prescription drug coverage insurance. Most people do have to pay a premium for this coverage. Plans vary and cover different drugs, but all medically necessary drugs are covered. You can choose what drug plan will be best suited to your needs.
Go To: Part D
How Can I Cover Additional Expenses?
Original Medicare Plans do not cover everything. Costs that you may incur include co-insurance, co-pays, deductibles, etc. These costs are called gaps. To help cover these costs you might want to buy a Medigap policy.
Another option is Medicaid. Medicaid is a combination of federal and state programs to help cover medical costs. Eligibility depends on your income as well as the ability to meet specific requirements.
If you are new to Medicare, the first thing you need to do is decide which plan will fit your needs. Be sure to check if your current insurance works with Medicare and determine if you need help paying for additional health care costs. You will also need to schedule a "Welcome to Medicare" physical exam with a doctor. Don't forget to ask your doctor about any preventive services he might recommend. Decide if you need prescription drug coverage. Then, you should contact a Medicare representative to enroll.