What is Medicare? – Overview
Medicare is a Government-backed health insurance program that pays almost the total for hospital stays and other expenses for health-related issues.
This program covers a range of treatments and services you must pay to the hospitals and the doctors.
Every citizen should enroll in any available Medicare programs as soon as they become eligible.
The federal department has recently revised the services offered under this health insurance program discussed in this article.
Figuring out when to enroll in this program is a bit of a difficult task as this program has different categories you must understand before enrolling. Let’s dive into the details!
What is Medicare?
Medicare is a US Federal Program designed for individuals 65 or older. Younger adults, too, can avail themselves of the same program if they are disabled or facing other health-related issues.
Medicare is different from other programs, i.e., Medicaid. A lot of people get confused between these two Government-backed health programs.
Today, we will give information about the Medicare program for adults 65 and above.
Different Parts of Medicare
Medicare has four different parts for different types of seniors with different problems.
Medicare Part A, Medicare Part B, Medicare Part C, and Medicare Part D are the four different types of Medicare programs.
These Medicare plans support additional supplement insurance plans that the users can utilize for other expenses.
Who is Eligible for the Medicare Insurance Program?
- Under specific conditions, you can enroll in this program to receive medical treatments.
- Any US Citizen or with Citizenship Status can enroll in this program.
- The program is open to Citizens with Health and Disability programs.
- Citizens with 65 years or above age can also enroll in this program.
How Does Medicare Health Insurance Work?
The essential Medicare Program is called Original Medicare. Sign up for this original Medicare program at a nearby Social Security Office.
Or you can even visit their online page to sign up and enroll in this program.
If you are comfortable with the online process, we recommend using it. It is way more convenient than visiting a Social Security office physically.
The original Medicare has two different types of facilities you can avail i.e., Medicare Part A and Medicare Part B. Let’s understand more about these plans.
Medicare Part A
Medicare Part A under the Original Medicare Program covers the following listed services. You won’t be charged if you use the below-listed services for your health-related problems and their treatments.
- Inpatient Visits to Hospitals
- Home Healthcare
- Special Nursing Care
- Hospice Care
You can avail of this institutional care under this part of Medicare, i.e., Medicare Part A.
In general, most employers pay for the Medicare Part A premiums on behalf of their employees as a tax.
Each of their employees is covered with this basic Medicare plan. The employers directly pay the premiums to the government in terms of tax.
Medicare Part A will ask you to pay for additional services from your pocket as it is the basic plan only.
This part of Medicare does not cover full expenses. You must pay for part of the treatment and services you utilize from your pocket.
The deductible for Part A Medicare in 2024 is $1,632. You have to pay this deductible for every benefit that you receive from the hospitals.
This Medicare covers your expenses from the first day to 60 days of your discharge.
Medicare Part B
This part of Medicare covers most outpatient medical services. The services included in this Medicare Part are listed below:
- All types of Diagnosis tests, including labs, MRIs, X-rays, etc.
- Therapy Visits
- Doctors Visits
- Chemotherapy and other cancer treatments
You can enroll for this part of Medicare through the Monthly Premium option. Just like Part A, Medicare Part B does not cover the full 100% of expenses.
You will have to spend some for additional treatments and services from your pocket.
Prescription drugs suggested by your Doctor will not be covered under this part.
This means when you have to buy prescribed medicines, you will have to pay for the same as it is not covered under this program.
You must pay the set deductible every time you visit the hospital, as this program doesn’t cover a full year’s medical expenses.
What are the other options available?
Besides the Original Medicare Program, many people want additional benefits as they fear spending high on medical expenses.
Unlike Medicare Part A and Medicare Part B, the same program provides two other options i.e., Medicare Part C and Medicare Part D.
Medicare Part C
Medicare Part C is also known as the Medicare Advantage plan. This plan can be utilized as an alternative to the Original Medicare plan.
You won’t be able to receive the benefits of Part A and Part B as soon as you enroll with Medicare Part C.
Unlike Medicare Part A and Medicare Part B, which are covered by the Federal Department, Medicare Part C, i.e., the Medicare Advantage plan, is provided by private companies.
You can enroll yourself from privacy insurers to Medicare Part C.
Most people enroll themselves in Medicare Plan C because it covers additional expenses, unlike Medicare Part A and Medicare Part B.
Medicare Part C also provides transportation, fitness-related expenses, and many other services not included in the Original Medicare.
The Medicare Advantage plan provides a fixed amount for out-of-pocket expenses during hospitalization and other health-related expenses.
This part of Medicare covers other expenses and provides general health services at discounted rates.
To enroll in the Medicare Advantage plan, you have to be enrolled with Medicare Part A and Medicare Part B.
Even after enrolling in Medicare Part C, you must keep paying the premiums for Medicare Part B. There are no age restrictions to avail of this part.
Medicare Part D
Medicare Part D is also known as the Prescription Drug Plan. This is the most recent part added by the Federal Authority to improve the health infrastructure.
This part was added in 2016. Just like Medicare Part C, Medicare Part D is provided by third parties, i.e. private insurers.
Medicare Part D covers your prescribed drugs. The annual deductible of Medicare Part D is $545 in 2024.
You will be asked to pay a copayment for the prescribed drugs. The rest will be paid under this Part of the Medicare Program.
There is a limit to spending on prescribed drugs every year. You will be understood by the insurers from which you will enroll for this part.
You must be enrolled in Part A or B to enroll in this program. As per the resources, every American should enroll in this program as soon as they become eligible.
Medicare Advantage plan covers drug expenses and other benefits. You will be guided about the same while enrolling in this program.
As noted above, besides all these parts, including the Original Medicare Program, there is an additional plan called the Medicare Supplement Insurance Program.
Let’s collect some more information about this program.
What is the Medicare Supplement Insurance Program?
Just like the Medicare Advantage plan, the Medicare Supplement Insurance Program is issued by private insurers.
These insurers work alongside the government’s program and will pay a sum from the expenses. This plan is there to cover up the gaps that you made and hence you need not put a hole in your pocket.
As per your requirements, you can avail of the desired plan from the provider. You will have to pay extra for comprehensive coverage apart from the existing plans.
Citizens can visit any clinic nationwide when they enroll for this Medicare Supplement Insurance Program and a standard Medicare Advantage program.
This plan also doesn’t cover expenses against prescribed drugs.
If you are enrolled with Part A or Part B, you can enroll for this part. Depending on the stage in which you live, the plan and premiums may vary.
You must get all the details from the insurer before enrolling in the Medicare Program.
Medicare Coverage List
Does Medicare Cover Annual Physicals?
If someone qualifies for the Initial Preventive Physical Examination (IPPE), they can receive Medicare coverage for annual physicals. Individuals who turn 65 are eligible to apply for this program. Disability applicants, however, must submit their applications early.
Is outpatient care covered by Medicare?
Each Medicare component has an independent cost and includes multiple services. Medicare Part B generally offers coverage for outpatient care, including different diagnostic tests, doctor visits, therapy sessions, chemotherapy, and other cancer treatments.
Can You Have Medicare and Medicaid at the Same Time?
Yes, if a person is over 65 years old or has a disability, they may be eligible for Medicare. If that same person can also fulfill their state-specific eligibility criteria, they become eligible for Medicaid.
These people are usually referred to as “dual eligible” and can enjoy the benefits of Medicaid and Medicare at the same time .
What is Medicare? Take Away!
You may visit their official website for any queries regarding the Medicare Program and its benefits.
You can get all the details from their official website and can even sign up yourself to enroll if you are eligible. You can also contact the Social Security Office or apply through their official portal.