What is Medicare? Everything You Need to Know

Medicare is the federal health insurance program in the United States that provides coverage for individuals aged 65 and older, as well as younger people with certain disabilities. It helps with the cost of healthcare, but it doesn't cover all medical expenses.

In this guide, you'll learn:

The different parts of Medicare and what they cover.
Eligibility and enrollment requirements.
The costs associated with Medicare.
How Medicare fits into the broader healthcare system.

Parts of Medicare

Medicare is divided into several parts, each covering different services.

Part A (Hospital Insurance)

Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.

Part B (Medical Insurance)

Covers doctors' services, outpatient care, preventive services, and some home health care.

Part C (Medicare Advantage)

Private health plans that offer all Part A and Part B benefits, and often additional benefits like vision, dental, and hearing.

Part D (Prescription Drug Coverage)

Helps cover the cost of prescription drugs.

Eligibility and Enrollment

Understanding eligibility and enrollment is crucial.

Age Requirement

Generally, you must be 65 or older to qualify.

Disability Requirement

Younger individuals with certain disabilities may also qualify.

Enrollment Periods

Initial Enrollment Period, General Enrollment Period, and Special Enrollment Period.

Costs of Medicare

Medicare involves various costs.

Premiums

Monthly payments for Parts B and D, and sometimes Part A.

Deductibles

Amounts you pay before Medicare starts paying.

Coinsurance and Copayments

Amounts you pay for services after you meet your deductible.

Medicare in the Healthcare System

Medicare plays a significant role in the US healthcare system.

Federal Program

Administered by the Centers for Medicare & Medicaid Services (CMS).

Supplementing Coverage

Many individuals purchase supplemental insurance (Medigap) to cover out-of-pocket costs.

Impact on Healthcare Providers

Influences how healthcare providers are reimbursed.

Conclusion

Medicare is a vital federal program providing health insurance to seniors and individuals with disabilities. Understanding its parts, eligibility, costs, and role in the healthcare system is essential for navigating your healthcare options. For more insight into how this concept interacts with others, see our detailed guide on Health Insurance, which further explores the broader landscape of health coverage options and their implications in greater depth.

Medicare FAQs

Is Medicare or Medicaid?

Medicare:

A federal health insurance program primarily for people aged 65 or older, and some younger people with disabilities.
It's based on age or disability.

Medicaid:

A joint federal and state program that provides health coverage to eligible low-income individuals and families.
It's based on income.

Does everyone have to pay $170 a month for Medicare?

The standard monthly premium for Medicare Part B can change yearly.

While that figure is close to current standards, not everyone pays the same amount.

Factors that influence the amount paid include:

Your income level. Higher-income individuals may pay more.
When you enrolled in Medicare.
Therefore, while many people do pay a similar amount, it is not a set number for everyone.

What is Medicare for what age?

The primary age of eligibility for Medicare is 65.

However, younger individuals with certain disabilities, such as those with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS), may also qualify.

What are the 6 things Medicare doesn't cover?

Medicare, particularly Original Medicare (Parts A and B), has limitations. Here are some key areas it typically doesn't cover:

Routine Dental Care: Most dental procedures, including cleanings, fillings, and dentures.
Routine Vision Care: Routine eye exams, eyeglasses, and contact lenses.
Hearing Aids: Hearing aids and related hearing exams.
Long-Term Care: Custodial care, such as help with bathing, dressing, and eating.
Most Care Outside the U.S.: Healthcare received while traveling abroad.
Routine Foot Care: routine podiatry.

It's important to note that Medicare Advantage (Part C) plans may offer some coverage for these services.