Medicare can be a confusing topic. It can bring up many questions that might be difficult to understand. In this blog, we will cover the basics of Medicare to help you understand whether Medicare is right for you, and how you can get the most out of Medicare insurance.
What is Medicare and who can get it?
Medicare is a federal health insurance program for people who are 65 or older. Some people younger than age 65 may also be eligible for Medicare. This includes individuals living with certain disabilities, permanent kidney failure, or amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig’s disease).
Medicare helps with the cost of health care, but it does not cover all medical expenses or the cost of most long-term care. There are four different parts of Medicare that offer different levels of insurance coverage.
How is Medicare different from Medicaid?
It is easy to get Medicaid and Medicare mixed up because they sound so similar.
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- Medicare: A federal insurance program for people who are 65 or older and people who are living with certain medical conditions.
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- Medicaid: A joint federal and state program that helps pay health care costs for individuals and families with limited income and resources.
Some people can have both Medicaid and Medicare, and these benefits can work together to cover most of your health care costs. If you qualify for both, you are considered “Dual Eligible.” To read our blog post about Navigating the Transition from Medicaid to Medicare, click HERE.
What are the four parts of Medicare?
Part A – Hospital Insurance
This part of Medicare covers inpatient hospital care. It covers everything that is crucial for your treatment while you are in the hospital. The federal government provides Part A, and most people do not pay a monthly premium for it. If you are admitted to a hospital, there is a deductible and some additional cost sharing that you will have to pay.
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- Deductible: The amount you pay for covered health care services before your insurance plan starts to pay. This amount may change each year.
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Premium: A monthly payment you make to maintain your health insurance coverage.
- Cost-sharing: The share of costs covered by your insurance that you pay out of your own pocket.
Part B – Medical Insurance
This part of Medicare covers doctors’ care when you are sick or treating ongoing medical conditions. Part B covers outpatient hospital and clinic care, lab tests, and some nursing care at home for participants who are homebound. Part B makes it easier to get preventative care, like your annual wellness exam, preventative screenings, and yearly flu shots.
The federal government provides also Part B, and participants pay a monthly premium. For visits to the doctor, part B also has a deductible and some cost sharing that you pay.
Part C – Medicare Advantage
Part C of Medicare offers an alternative way to receive Medicare benefits: an all-in-one option that replaces Part A and B and offers extra benefits. Many Medicare Advantage plans include prescription drug coverage as well as dental and vision care.
NOTE: Medicare Advantage is offered by private insurance companies and not by the federal government.
Part D – Prescription Drug Coverage.
Part D of Medicare covers prescription medications and is also offered by private insurance companies. If you have Medicare Part D, you will need to pay a monthly premium and a yearly deductible. You will also pay a coinsurance or a copay for your medications.
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- Coinsurance: A percentage of the cost for your prescriptions.
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- Copay: A flat fee for some of your prescriptions’ costs.
Interested in learning more about Medicare? Discover more in our Community Enrichment series! These webinars provide information to help you achieve your goals for a meaningful life. Click here to discover our upcoming sessions.
