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What Is Medicare?

Understanding Medicare:

A Comprehensive Overview

Medicare is a federal program designed to provide health insurance for people aged 65 and older, as well as certain younger individuals with disabilities or specific health conditions like End-Stage Renal Disease (ESRD)

Medicare is broken down into four different parts, each covering different aspects of healthcare:

Medicare Part A
(Hospital Insurance)

Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

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Medicare Part B
(Medical Insurance)

Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services.

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Medicare Part C
(Medicare Advantage)

A type of Medicare health plan offered by private companies that contract with Medicare. Medicare Advantage Plans provide all of your Part A and Part B benefits and often include additional benefits like vision, dental, and hearing coverage.

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Medicare Part D
(Prescription Drug Coverage)

Part D adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans.

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It’s essential to understand that Original Medicare doesn't cover everything. For instance, long-term care, most dental care, eye examinations related to prescription glasses, and more are not covered. That's where Medicare Supplemental Insurance (Medigap) can come into play to help cover some remaining healthcare costs.

Navigating Medicare can be confusing, especially when you're new to it. That’s where Medicarist.com comes in. We provide personalized assistance, helping you find, compare, and enroll in Medicare plans that fit your specific needs.

Remember, the right plan for you depends on your health needs, your budget, and the doctors and hospitals you want to use. Contact us today at (866) 857-3788 to discuss your options with a licensed agent.

Keep checking back on our blog for more detailed posts about each aspect of Medicare. Your understanding is our priority.

Understanding Medicare Part A:

Your Guide to Hospital Insurance

Medicare Part A, often referred to as hospital insurance, is one component of Medicare's four-part structure. It's designed to cover costs related to inpatient care. Here's a more detailed look at what Medicare Part A entails.

What Does Medicare Part A Cover?

Medicare Part A primarily covers:

  • Inpatient Hospital Care: This includes semi-private rooms, meals, general nursing, drugs as part of your inpatient treatment, and other hospital services and supplies.
  • Skilled Nursing Facility Care: Part A covers semi-private rooms, meals, skilled nursing and rehabilitative services, and other services and supplies only after a related three-day qualifying inpatient hospital stay for the same illness.
  • Hospice Care: If you meet certain criteria, Medicare Part A covers your hospice care costs, including nursing care, medical social services, and prescribed drugs for symptom control and pain relief.
  • Home Health Care: This includes intermittent skilled nursing care, physical therapy, speech-language pathology services, continued occupational services, and more.

Who is Eligible for Medicare Part A?

Generally, you are eligible for Medicare Part A if you are:

  • Aged 65 or older, and you or your spouse have paid Medicare taxes for at least 40 quarters (10 years).
  • Under 65, disabled, and have been receiving either Social Security or the Railroad Retirement Board disability benefits for 24 months.
  • Any age and suffer from End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS, also called Lou Gehrig's disease).

Costs Associated with Medicare Part A

For many people, Part A is premium-free if they or their spouse paid Medicare taxes while working. If you have to buy Part A, you'll pay up to $471 each month in 2021. The amount changes each year.

Part A also comes with other out-of-pocket costs, including deductibles and coinsurances. In 2021, the deductible for each benefit period is $1,484. After your deductible is met, you'll also pay a coinsurance for each day of each benefit period.

Medicare can be complex, and understanding what each part covers is essential to ensure you get the right coverage for your needs. Remember, Medicare Part A is just one part of your healthcare coverage.

Understanding Medicare Part B:

Your Guide to Medical Insurance

Medicare Part B, often referred to as medical insurance, is a key part of the Medicare structure. Designed to cover various outpatient services, it ensures you have access to necessary medical care. Let's dive deeper into what Medicare Part B covers.

What Does Medicare Part B Cover?

Medicare Part B primarily covers:

  • Doctors' Services:This includes office visits to primary care physicians and specialists, along with telehealth services
  • Preventive Services: These include screenings, vaccinations, and wellness visits to help detect health problems early when treatment is most effective.
  • Outpatient Care: If you need care in a hospital outpatient department, Part B can cover this.
  • Home Health Services: Similar to Part A, Part B can cover some home health care services, typically physical and occupational therapy.
  • Durable Medical Equipment (DME): This includes medically necessary items like wheelchairs, walkers, and oxygen equipment.

Who is Eligible for Medicare Part A?

You are eligible for Medicare Part B if you're 65 or older, under 65 with certain disabilities, or of any age with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS).

Costs Associated with Medicare Part B

Medicare Part B does come with a monthly premium. As of 2021, the standard Part B premium is $148.50. Some people may pay less due to the 'hold harmless' provision, which ensures that Social Security benefits do not decrease due to increasing Medicare Part B premiums. On the other hand, people with higher income may pay more due to the Income-Related Monthly Adjustment Amount (IRMAA).

In addition to the premium, Medicare Part B also has a yearly deductible. For 2021, the deductible is $203. After your deductible is met, you typically pay 20% of the Medicare-approved amount for most doctor services, outpatient therapy, and durable medical equipment.

Stay connected with our blog for more detailed posts about each aspect of Medicare. We're here to ensure you fully understand your healthcare options.

Understanding Medicare Part C:

Your Guide to Medicare Advantage Plans

Medicare Part C, also known as Medicare Advantage, is an all-in-one alternative to Original Medicare (Parts A and B). These plans are offered by private companies approved by Medicare. Here's a closer look at what Medicare Part C involves.

What Does Medicare Part C Cover?

Medicare Part C plans:

  • Must cover all services that Original Medicare covers: Part C plans must cover everything included in Parts A and B, except for hospice care (still covered under Part A).
  • May offer additional benefits: Many Part C plans provide extra benefits that Original Medicare does not cover, such as hearing, dental, vision, and wellness programs.
  • Usually include Medicare prescription drug coverage (Part D):Most Medicare Advantage Plans include prescription drug coverage.

Who is Eligible for Medicare Part C?

You're eligible to join a Medicare Advantage Plan if you have Part A and Part B, live in the service area of the plan you want to join, and you don't have End-Stage Renal Disease (ESRD). There are exceptions for individuals with ESRD.

Costs Associated with Medicare Part C

The costs of Medicare Part C vary depending on the plan. You typically have to pay your Part B premium along with any premium the Part C plan might charge. Additionally, your plan may have a yearly deductible and other out-of-pocket costs. Each plan can set its own terms for how you pay your share of the cost for services, so it's essential to understand these terms before choosing a plan.

 

Medicare vs. Medicare Advantage: Understanding Your Choices

Medicare and Medicare Advantage: two different choices, but what do they mean? Understanding the differences between Original Medicare and Medicare Advantage (Part C) can help you make the best healthcare decisions for your needs.

Original Medicare:

Original Medicare includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). It's provided by the federal government and gives you the flexibility to visit any doctor or hospital that accepts Medicare, without the need for a referral.

Original Medicare covers:

  • Inpatient hospital stays (Part A)
  • Skilled nursing facility care (Part A)
  • Some home health care services (Part A)
  • Doctors' services (Part B)
  • Outpatient care (Part B)
  • Preventive services (Part B)
  • Durable medical equipment (Part B)

However, Original Medicare doesn't cover everything. For instance, it doesn't typically cover prescription drugs, and you might have to pay a certain amount of out-of-pocket costs.

Medicare Advantage (Part C):

Medicare Advantage is an alternative to Original Medicare, offered by private companies approved by Medicare. These plans must cover everything that Original Medicare covers, but they can also offer additional benefits.

>Medicare Advantage Plans often cover:

  • Everything covered by Original Medicare (except hospice care, which is still covered under Part A)
  • Prescription drugs
  • Additional benefits like hearing, dental, vision, and wellness programs

>Medicare Advantage Plans may have networks, meaning you might need to visit doctors and hospitals within the plan's network for the lowest costs.

 

Which One is Right for You?

The right plan for you depends on your health needs, your budget, and the doctors and hospitals you want to use. Here are some questions to consider:

  • Do you prefer a wider choice of providers or are you comfortable with a network of providers?
  • Do you need additional benefits not offered by Original Medicare?
  • What can you afford in terms of premiums, deductibles, and other out-of-pocket costs?

Keep checking our blog for more detailed posts about all things Medicare. Your understanding is our priority.

Understanding Medicare Part D:

Your Guide to Prescription Drug Coverage

Medicare Part D, also known as Prescription Drug Coverage, is an important part of the Medicare program. It assists beneficiaries with the cost of prescription drugs and is offered by insurance companies and other private companies approved by Medicare. Let's take a closer look at what Medicare Part D covers.

What Does Medicare Part D Cover?

Medicare Part D plans must cover a broad range of prescription drugs, including:

  • All commercially available vaccines not covered by Part B.
  • At least two drugs in the most commonly prescribed categories and classes.
  • At least two drugs in the most commonly prescribed categories and classes.
  • Certain types of drugs, such as antidepressants, antipsychotics, HIV/AIDS drugs, cancer drugs, immunosuppressants, and seizure medications.

Each Part D plan has a list of covered drugs called a formulary. While formularies can vary by plan, they must all meet certain standards set by Medicare.

Who is Eligible for Medicare Part D?

Anyone who has Medicare Part A and/or Part B is eligible to enroll in a Part D plan. It's important to note that if you have a Medicare Advantage Plan that includes prescription drug coverage, you should not enroll in a standalone Part D plan.

Costs Associated with Medicare Part D

Part D costs vary greatly depending on the specific plan. Costs include a monthly premium, yearly deductible (not more than $445 in 2021), copayments/coinsurance, and costs in the coverage gap (also known as the "donut hole"). Some people may qualify for Extra Help to pay for their Part D costs.

Stay connected with our blog for more educational posts about Medicare. We're committed to helping you understand your healthcare options.