What is Medicare in simple terms?

Like most people, you probably have many questions about Medicare. What is it? How does it work? What are the benefits? Is it right for me? In this post, we’ll try to answer some of those questions and provide a basic overview of Medicare. But if you still have questions after reading this, be sure to contact our team – we’d be happy to help!

What is Medicare in simple terms?
John Ramsey

Key Takeaways

  • Medicare is an excellent program for those over 65 and older or with specific disabilities.
  • Medicare is a great way to get the medical care that you need. There are four parts, Part A (Hospitalization) and Parts B (Doctor services) as well as Part C (Medicare Advantage) and Part D (Prescription Drugs).
  • With Medicare Advantage plans, you may be covered for vision and dental care as well.

Table of Content

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.

What is Medicare in simple terms: Frequently Asked Question

What is the purpose of having Medicare?

The purpose of Medicare is to provide financial security to people who are no longer earning their income. This allows them to enjoy some of life's necessities such as medications, doctor visits, and hospital stays without too much worry about the costs involved.

What's the difference between Medicaid and Medicare?

Medicaid is a program that offers medical benefits to those deemed financially unable to pay for their own. It's only available in certain states and typically depends on income and other factors such as age, disability status, etc.; in some cases, the individual has to be younger than 65 years of age.
Medicare is available to all individuals 65 years of age or older, have worked for at least ten years, or are disabled. They must also be residents of the United States and pay into the system through taxes taken out of their paycheck throughout their working careers.

Does everyone get Medicare?

Everyone eligible gets Medicare. However, they must pay into the system through taxes to receive it when they need it. It's a contract between the individual and the government guaranteeing payment in exchange for lifelong monetary contribution from each employed person covered by the plan.

Who paid for Medicare?

Medicare is funded primarily by payroll taxes, premiums paid by beneficiaries, and general U.S. Treasury revenue sources.
What are the three criteria for Medicare eligibility?You must be age 65 or older. You must have worked at least ten years in employment that qualified for Social Security coverage. In addition, you need to have been a legal U.S. resident the entire time Medicare covers you.

Why do I have to wait two years for Medicare?

If you are under the age of 65, you must have a disability that prevents you from working or earning enough money to support yourself for two years to be eligible for Medicare.

How long does it take to get approved for Medicare?

Applying for Medicare can be done at any time during the 8.5 months before your 65th birthday or after your 65th birthday, as long as you have worked and paid into Social Security (or been married to someone who has). However, if you choose to apply within 8.5 months of your 65th birthday, you will get your Medicare card immediately, but you have to wait until the three months before your birthday month to use it.

Does Social Security automatically deduct Medicare?

They can if you want them to. However, your Social Security benefits will not be reduced by your Medicare premiums if you reject Medicare.

Does Medicare cover all medical costs?

No, Medicare has copay and co-insurance amounts, and they only apply to some medical care and supplies. For example, Medicare does not cover most dental, vision, or long-term nursing home costs. However, you may get a plan from an insurance company to cover the rest.

Can you get Medicare Part B for free?

No, Medicare Part B premiums are deducted from Social Security payments. However, there are assistance programs available to help with costs.

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