What is Medicare?
Medicare is a federal program that helps Americans get healthcare. The program was established under the 1965 Social Security Act by Congress for older Americans with no health insurance. In addition, this program provides for the treatment of a wide range of populations such as seniors, people with specific disabilities, and with end-stage kidney disease. The four parts of Medicare are outlined in the following section.
The four parts of Medicare
- Medicare Part A covers hospital services. It also helps pay for home health care, hospice care, and inpatient care.
- Medicare Part B helps cover doctor services, outpatient treatment, and other costs associated with having a chronic condition. It also covers preventive services.
- Medicare Part D, which started in 2006, helps people with prescription medications.
- Medicare Part C is also known as Medicare Advantage Plan, where it helps seniors get complete coverage for their healthcare needs through private insurance companies that contract with Medicare. Part C combines Part A and Part B.
Medicare Supplement Plans
Since Medicare alone does not cover all of a recipient's medical expenses, insurers sometimes supplement the program's "Medicare Supplement Plans" or Medigap. These plans can also be referred to as MedSupp, Medicare Supplement, or MedSup. The term "Medigap" is a shortening of "Medicare Supplemental." These are insurance plans designed to help Medicare beneficiaries pay for services not covered under Parts A and B. This can include co-insurance, co-pays, and deductibles.
Note: Medicare Supplement Plan does not include drug coverage.
What is not covered by Original Medicare?
Long-term care or supervised care is potentially the most significant expense that can't be refunded or paid. Medicaid pays custodial costs and is often only offered to low-income individuals who have little or no savings. Typically Medicare does not reimburse hearing aids or hearing examinations. Eye Exam Lenses. Denture. Almost all dentistry services. Most footwear care except when diabetes or a medical need arises. Healthcare in another country. Cosmetic surgery.
Note: Medicare Advantage plans include vision, hearing, and dental benefits.
Is Medicare free?
Medicare Part A premiums are generally not required for those who have paid Medicare taxes for ten years (40 quarters) or more. Medicare tax is part of payroll taxes taken out of most workers' wages. Beneficiaries of Medicare will pay a monthly Part B premium that rises each year on January 1st. You may have to pay a premium for Part C or Part D if you choose a plan with a premium. All Medicare Supplement Plans have a premium.
Who is eligible for Medicare?
People who are eligible for Medicare include:
- Americans age 65 or older. Regardless of age, people who receive Social Security Disability benefits (or have received them in the past) may also qualify.
- People under the age of 65 with disabilities and specific diseases such as Amyotrophic Lateral Sclerosis, Parkinson's Disease, kidney failure, and End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant. People with Lou Gehrig's Disease (ALS), Multiple Sclerosis.
- People who have been receiving Social Security benefits for at least 24 months.
How do I enroll in Medicare?
Once you reach 65, you will automatically enroll in Medicare Part A for hospital care. It does not require any commitment for enrollment. However, you have to contact Social Security Administration to enroll in Medicare Part B. Under Part B, you will have to pay a monthly premium and meet the exact eligibility requirements as above. In addition, Medicare Advantage plans require a separate application process.
What happens after I apply?
If your application is approved, you will receive a Medicare card in the mail. This card must be presented at every doctor's appointment before receiving treatment or other medical care. You have to contact Social Security Administration if you do not receive a card.
The bottom line
Medicare is a federal government plan which subsidizes healthcare services. It includes people over 65 and older, and those with special eligibility conditions.
Medicare Advantage Plans are insurance plans designed to help Medicare beneficiaries pay for services not covered under Parts A and B. This includes vision, dental, hearing, and prescription drugs coverage.
Medicare Supplement Plans(Medigap) cover co-insurance, co-pays, and deductibles for Part A and Part B.