Medicare Overview

medicare overview

Insurance is a long-time investment for Americans. Medicare is a federal health insurance program enacted with the Social Security Amendments of 1965

This legislation created Medicare to cover the cost of hospitalization, nursing home care, and some other medical expenses for U.S citizens who are over 65 years old or who meet specific disability requirements. The term Medicare was first appropriated by Congress in 1966 when the social health insurance program was established. 

The federal government is responsible for administering the Medicare program, but each state has the option to add coverage to what the federal government offers. Here we will discuss Medicare’s parts, eligibility, and how the program works.

1. Part A Inpatient/Hospital Coverage

Part A is considered the “original Medicare.” It covers inpatient hospital care, skilled nursing care, hospice services, and some home health services. It also helps pay for short-term rehabilitation services after a hospital stay of three days or more. Part A coverage is free for qualified people and stays with an individual even if they move to a different state. 

This part of Medicare also offers limited coverage for individuals under 65 years with a disability that began before 65 and meets specific rules. To enroll, you must visit a specific Medicare office. You need to show proof of U.S citizenship or why you are qualified to enlist in government benefits. During the interview, you will need to provide your social security number and personal health information. 

After this is done, you will be issued a Medicare card. Part A has rules and regulations, including a maximum on the amount you are responsible for during your lifetime. This amount is known as the “average” lifetime benefit that the Social Security Administration calculates. Also, Medicare part a does not usually cover emergency room visits, according to Clearmach Medicare.

medicare - emergency

2. Part B Outpatient/Medical Coverage

If enrolled in Part B, you can receive Medicare benefits to help pay past-due doctor bills and medical services like home health services or outpatient surgery. Part B also pays for some prescription drugs and supplies that you need during your lifetime. The cover for this part of Medicare can be different for each individual. 

A person may pay a higher premium or have more benefits than someone else. Some people can also get extra benefits once per lifetime if they meet certain requirements, including never having a drug-referred prescription. Part B is paid for by monthly premiums, deductibles, and cost-sharing. 

You are responsible for your premiums and deductibles if you have Original Medicare. Other costs like co-pays and coinsurance are not a problem unless Medicare’s rules say so. When you enroll, you are given a choice of plans and have to decide which is most reasonable. Outpatient services you can receive include doctor’s office and clinic visits, lab tests, diagnostic services, x-rays, and consultations. 

Before you use any of the services, you must have a signed contract with your doctor. The contract will include the type of services, reimbursements, and any other special agreements.

medicare part b

3. Part C Medicare Advantage Plan

This version is governed by Medicare and offers different programs, including prescription drug coverage, medical equipment, and dental care. All these are offered through private companies approved by Medicare to provide particular benefits. These companies are licensed by Medicare and must be certified by the Federal Drug Administration

The companies also have to meet certain criteria set by federal law. The service differs from Original Medicare in that it offers additional benefits not provided by the federal government. This can include getting an eyeglass prescription to paying for specialty dental plans. You have many options to choose from, so finding a plan that works for you is not difficult. 

The cost of these plans depends on the area you live in, your preferred plan, and your level of health. You can combine Part C with Part A and B, or you can just get Part C benefits. This is a valuable option for seniors who want to supplement their coverage.

medicare patient

4. Part D Prescription Drug Coverage

This benefit helps pay for prescription medication. Since people over 65 are more likely to need medications than anyone else, this benefit is essential. This part of Medicare works with Part B and Part A to offer a combined service for prescription drug coverage. Some people already have access to these drugs through private insurance plans or Medicaid. 

You must ensure that you are taking advantage of the total benefits offered. If you did not plan for it in advance, this could be a problem. Part D covers about 50 prescription drugs. The program has many options for seniors, including generic and brand-name drugs, multiple drug plans, and plans with special features. 

Part D coverage is free to enrollees, but there is a co-pay for doctors and other specialized healthcare providers. The co-pay must be paid at the time of service, not afterward. If you are on a Medicare subsidy, you should always get these prescriptions from a provider before making any payment.

The Medicare program has many options for seniors to choose from. This can be confusing because of the many choices and differences. Researching the program and seeing what works best for your situation is vital. Consider all aspects of the program, including what things cost and how much money you have to pay. The plan can be beneficial and provide everything you need without looking elsewhere.

Last Updated on September 5, 2022

Health Listed is committed to providing the latest and greatest health information to our loyal readers. Whether you want to learn more about nutrition, fitness, or anything else health-related, we cover it all!