What is Medicare – Overview
Medicare is a Government-backed health insurance program that helps cover hospital stays and other medical expenses, often requiring co-pays, deductibles, and coinsurance.
This program covers a range of treatments and services you must pay to the hospitals and the doctors.
Eligible individuals should consider enrolling in Medicare when they become eligible to avoid late enrollment penalties.
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 can be challenging, as there are 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, such as Medicaid. Many 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 parts designed to cover specific services: Part A for hospital insurance, Part B for medical insurance, Part C for Medicare Advantage plans, and Part D for prescription drug coverage.
Medicare Part A, Part B, Part C, and 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 aged 65 years or above 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 physically visiting a Social Security office.
Original Medicare has two different types of facilities you can use: Medicare Part A and Medicare Part B. Let’s learn 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.
Most people do not pay a monthly premium for Medicare Part A because they or their spouse paid Medicare taxes while working.
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 is the basic plan only, so you must pay out of pocket for additional services.
This part of Medicare does not cover all expenses. You must pay for part of the treatment and services you utilize out of your own pocket.
The deductible for Medicare Part A in 2024 is $1,632, which covers the beneficiary’s hospital expenses for each benefit period.
This Medicare covers your expenses from the first day to 60 days after 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 lab tests, 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 by 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.
Medicare Part D was established in 2006. Just like Medicare Part C, Medicare Part D is provided by third parties, i.e. private insurers.
Medicare Part D covers prescription drugs, with the annual deductible varying by plan.
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 either Part A or Part B to enroll in Medicare Part D. 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 you do not need to put a hole in your pocket.
You can choose the desired plan from the provider according to your requirements. In addition to the existing plans, you will have to pay extra for comprehensive coverage.
Citizens can visit any clinic nationwide when they enroll for this Medicare Supplement Insurance Program and a standard Medicare Advantage program.
Medicare Supplement Insurance (Medigap) plans do not cover prescription drugs; these costs are typically covered under Medicare Part D.
You can enroll for this part if you are enrolled with Part A or Part B. The plan and premiums may vary depending on your stage of life.
You must get all the details from the insurer before enrolling in the Medicare Program.
Medicare Coverage List
FAQs
Does Medicare Cover Annual Physicals?
Medicare covers the Initial Preventive Physical Examination (IPPE) also known as the 'Welcome to Medicare' preventive visit once. For subsequent years, Medicare covers an Annual Wellness Visit, which is not the same as a full physical examination. All new Medicare enrollees are eligible for the IPPE within the first 12 months of Part B enrollment, regardless of age. There is no need for disability applicants to submit their applications early specifically for the IPPE.
Is outpatient care covered by Medicare?
Each part of Medicare has its own set of costs, such as premiums, deductibles, and co-pays, and covers different services. Medicare Part B generally offers coverage for outpatient care, including different diagnostic tests, doctor visits, therapy sessions, chemotherapy, and other cancer treatments.Â
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.
See Also
Medicare Approved DME Supplier List
Does Medicare Cover Nursing Homes?
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