Understanding what Medicare is is vital to your healthcare coverage and finances.
We are going to review the ins and outs of the Medicare insurance program and Medicare coverage.
What is Medicare (How Does it Work?)
Medicare is a national health insurance program for people ages 65 and older, in the United States. This health insurance plan is also for people with disabilities or end-stage kidney failure.
This insurance program is divided into different parts. Medicare Part A, Part B, Part C and the newest to the health insurance program is Medicare Part D.
Each part of the plan has different coverage so let’s map out these parts individually.
Part A – Hospital Coverage
Medicare Part A is an inpatient hospital insurance that covers part of the cost of inpatient care and nursing facilities. Medicare Part A will help with hospice and specialty home health care as well.
Part A will cover the cost of a semi-private room. Part A does not cover any treatments, scans, surgeries or anything of that nature.
Because majority of people ages 65 or older have worked for at least 10 years in their life the cost of Medicare Part A for those individuals is typically $0.
Most individuals that don’t qualify for the premium free coverage, they can still apply for it. However, the cost of this monthly premium is quite high.
Part B – Doctor Visits
Medicare Part B is an outpatient medical insurance that covers almost all your medical needs aside from the inpatient hospital fees. Part B covers doctor’s visits, lab work, surgeries and any preventive services needed.
If it is medically necessary, this plan will also cover ambulance services and medical equipment. This plan will also cover doctor’s visits while you are in the hospital as well.
There are very expensive treatments such as kidney dialysis as well as cancer therapy, part time or intermittent home health care, and therapy treatments such as physical therapy. Part B also includes a one-time “Welcome to Medicare” preventative visit, as well as shots like hepatitis b and the flu vaccine.
Medicare sets the cost of the Part B plan yearly and the cost may change. The cost price is income based, highest to lowest determined by your adjusted gross income.
Typically, the monthly premium is automatically taken out of their Social Security benefits. People who are eligible for premium-free Medicare Part A is eligible for Medicare Part B, all they must do is enroll and pay a monthly premium.
Part C – Medicare Advantage
Medicare Part C also known as the Medicare Advantage program, which is a private insurance. Think of this plan as something for long term care.
You must first be enrolled in Medicare Part A as well as Part B to enroll in this program. Part C is a voluntary program the cost will be determined by carrier, county of residence and the plan you select.
These private insurance companies are companies that Medicare approves and works with alongside of Original Medicare.
These plans are often referred to as Medicare replacement plans. Medicare coverage will come from Part C not from Original Medicare. Medicare Part C can be thought of as a ‘bundle package’.
Medicare Part C, or Medicare replacement plans, often offer extra coverage, like hearing, dental, or vision programs. Most of these programs will also include Medicare Part D as well.
Always keep in mind that during a future annual election period you may opt to return to Original Medicare if you choose.
Part D – Prescription Drug Coverage
Medicare Part D is coverage for prescription medication and treatments. Part D was created in 2006, making it the newest addition to the national health care program for patients age 65 and older. On average for the year 2018 monthly premiums are $34 across the nation.
Medicare Part D is typically a pharmacy card. It covers mail orders as well as medications from the pharmacy. The cost of the prescriptions will be determined on many factors.
Factors such as, the specific plan the individual chooses, the medications the individual uses as well as the pharmacy they go to. Pharmacies have different pricing, so it is important to look around for one that fits your individual needs per your insurance coverage.
To sign up for the Medicare Part D plan you must pick a carrier and then enroll in that carrier’s drug plan. There are many drug plans in each state to choose from. Have your agent help you determine which is the best plan for you.
What is Medicare Compared to Medicaid
Medicare is a national health insurance program for patients age 65 and older in the United States this program is available no matter your income.
Medicare is a federal program where as Medicaid is a state and federal program based on a person’s income. Medicaid is a national health insurance program for eligible low-income adults, children, pregnant women, elderly adults and people with disabilities.
Every state has Medicaid offices, here is where you can apply for several different Savings Programs; these programs may help pay for your Medicare part B premiums and they will also help aid with drug plans. You may apply within your state in office or online to see if you qualify for eligibility.
Can I Have Both Medicare and Medicaid?
As long as an individual qualifies for both Medicare and Medicaid, then yes; this would be considered being “dual eligible.” When a person is dual eligible, almost all of their healthcare costs will be covered by either Medicare or Medicaid.
If a person is 65 or older, as well as having a very low income they might qualify for eligibility for both programs.
What are Medicare Supplements
Medicare Part A & B only cover 80% of your medical costs, Medicare Supplements fill in the 20% coverage gap that beneficiaries are left responsible to pay out of pocket for. Medicare Supplements also pay for other out of pocket costs such as copays, deductibles and coinsurance.