What Is Medicare?

What Is Medicare?

Medicare is a national health insurance program in the United States that provides healthcare coverage to people who are aged 65 and over, as well as some younger individuals with certain disabilities or chronic conditions. The program was signed into law in 1965 as part of President Lyndon B. Johnson's Great Society domestic agenda.

Medicare is funded by a combination of payroll taxes, premiums paid by beneficiaries, and general government revenue. The program is administered by the Centers for Medicare & Medicaid Services (CMS), a division of the Department of Health and Human Services (HHS). There are four main parts of Medicare:

What Are the Four Parts of Medicare?

Part A: Hospital Insurance Part A covers inpatient hospital care, skilled nursing facility care, hospice care, and some home health care. Most beneficiaries do not pay a premium for Part A because they or their spouse paid Medicare taxes while working.

Part B: Medical Insurance Part B covers outpatient care, preventive services, doctor visits, durable medical equipment, and some home health care. Beneficiaries pay a monthly premium for Part B, and the amount is based on their income.

Part C: Medicare Advantage Part C, also known as Medicare Advantage, is an alternative to traditional Medicare. Beneficiaries can choose to enroll in a private insurance plan that provides all the benefits of Part A and Part B, and may also offer additional benefits such as dental and vision care. Beneficiaries typically pay a monthly premium for Part C, and may also pay additional costs such as copays and deductibles.

Part D: Prescription Drug Coverage Part D covers prescription drugs. Beneficiaries can enroll in a private insurance plan that offers Part D coverage, and may pay a monthly premium, deductible, copays, and coinsurance. Some low-income beneficiaries may be eligible for additional assistance with their Part D costs.

Additional Information About Medicare

In addition to these four parts, Medicare also offers some supplemental coverage options, such as Medigap policies, that can help cover costs that are not covered by traditional Medicare. It's important to note that Medicare does not cover all healthcare services or expenses. For example, it does not cover long-term care, dental care, or hearing aids. Beneficiaries may need to pay out of pocket or purchase additional insurance to cover these costs. Overall, Medicare provides critical healthcare coverage to millions of Americans. However, it can be complex to navigate, and beneficiaries may need to carefully consider their options to ensure they have the coverage they need.

Medicare Eligibility

Eligibility: As mentioned earlier, Medicare is generally available to individuals who are aged 65 or older, or younger individuals with certain disabilities or chronic conditions. To be eligible, you or your spouse must have worked and paid Medicare taxes for at least 10 years. Some individuals may also be eligible for Medicare if they have end-stage renal disease or amyotrophic lateral sclerosis (ALS).

Medicare Enrollment

Enrollment: If you are receiving Social Security benefits before you turn 65, you will be automatically enrolled in Medicare Part A and Part B. If you are not receiving Social Security benefits, you will need to sign up for Medicare during the initial enrollment period, which is typically a 7-month period that starts 3 months before your 65th birthday. You can also sign up for Medicare during a special enrollment period if you have certain qualifying events, such as losing employer-based coverage or moving to a new area.

Medicare Costs

Costs: Medicare costs vary depending on the parts of Medicare you are enrolled in, your income, and the healthcare services you use. Generally, Part A does not require a monthly premium, but you may be responsible for deductibles, coinsurance, and copayments. Part B requires a monthly premium, and the amount you pay will depend on your income. Part C and Part D also have monthly premiums, and you may be responsible for additional costs such as deductibles, copayments, and coinsurance.

Medicare Coverage Limitations

Coverage limitations: As mentioned earlier, Medicare does not cover all healthcare services or expenses. For example, it does not cover long-term care, dental care, hearing aids, or most vision care. However, some preventive services such as flu shots, certain cancer screenings, and annual wellness visits are covered. Beneficiaries may need to pay out of pocket or purchase additional insurance to cover some of these services.

Medicare Supplement Insurance - Medigap

Medigap: Medigap policies are supplemental insurance policies that can help cover some of the costs that are not covered by traditional Medicare, such as deductibles, copayments, and coinsurance. These policies are sold by private insurance companies and can only be purchased by individuals who are enrolled in Part A and Part B of Medicare.

Medicare Advantage

Medicare Advantage: Medicare Advantage plans are offered by private insurance companies as an alternative to traditional Medicare. These plans provide all the benefits of Part A and Part B, and may offer additional benefits such as dental and vision care. Some Medicare Advantage plans also include prescription drug coverage. Beneficiaries may need to pay additional costs such as copayments, coinsurance, and deductibles, and may be limited to using certain providers.

Medicare Prescription Drug Coverage

Prescription drug coverage: Medicare Part D provides prescription drug coverage for beneficiaries. These plans are offered by private insurance companies, and beneficiaries may need to pay a monthly premium, deductible, copayments, and coinsurance. Some low-income beneficiaries may be eligible for additional assistance with their Part D costs.

Medicare Access to Care

Access to care: Beneficiaries can receive care from any provider that accepts Medicare. However, some providers may not accept Medicare or may limit the number of Medicare patients they see. Beneficiaries may also need to navigate restrictions such as prior authorization or referrals for certain services.

Changes to Medicare

Changes to Medicare: Medicare is subject to ongoing changes and updates. Beneficiaries should stay informed about changes to Medicare policies, costs, and benefits, and carefully consider their options to ensure they have the coverage they need.

Let Us Help Today

For more information about the different Medicare options and to find the best MediGap plan in your area, contact us now. We can answer any questions you have and shop insurance companies that offer Medicare Supplements to make sure you get the best Medicare coverage for your situation. We are here 6 days a week and licensed in 30 different states to help with this. Call now to see if you qualify for great coverage with a great insurance company.
(512) 524-9826

As you approach Medicare eligbility, you should receive information from CMS in the mail, providing information about Medicare, Part D Prescription Drug Plans, Medicare Advantage Plans and Medicare Supplement Plans. This should help educate you about what to expect and how to choose the best Medicare plan. You can download the Medicare & You Handbook directly from Medicare, if you do not receive one in the mail.

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