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Medicare Definition (What is Medicare?)


By definition, Medicare is a federal health program funded by social security and Medicare taxes paid by employees. The Centers for Medicare and Medicaid Services (CMS) oversees the program. 

What Medicare Is

Medicare is broken into four parts: Plan A, Plan B, Plan C, and Plan D. But how does it work? We’re here to help you understand more about each Medicare plan and if you qualify.Medicare provides health insurance for:

  • Senior citizens ages 65 and older
  • Younger people with disabilities
  • People with arterial lateral sclerosis (ALS), or end-stage renal disease (ESRD)

Medicare Part A Definition

Part A pays for covers hospital coverage. Part A is there if you need a nursing facility, short-term respite care, and inpatient hospital visits. This part covers the cost of a semi-private room. Most patients aren’t responsible for a monthly premium with Part A because they have worked for more than forty quarters.

But, they may have a deductible of $1,484. Most people who don’t qualify for premium-free coverage can still apply for Part A, but this monthly premium cost is relatively high.

Medicare Part B Definition

Part B is your outpatient coverage. Part B helps cover doctor and specialist visits, labs, therapies, and more. The standard monthly premium for Part B is $148.50 and increases annually. If you have a higher income, this amount is subject to adjustment.

Part B covers ambulance services and medical equipment. Also, Part B will cover 80% of costly treatments such as kidney dialysis and cancer therapy, part-time or intermittent home health care, and physical therapy. Further, Part B includes a one-time Welcome to Medicare preventative visit and shots such as those protecting against Hepatitis B and the flu. If you’re eligible for Part A, you can also get Part B.

Medicare Part C Definition

Medicare Advantage is a plan managed by a private health care company that offers more benefits than Parts A and B. Some of the additional coverage may include vision, dental, and hearing benefits. Often, these plans also include perks such as a gym membership.

Advantage plans usually come in the form of HMOs and PPOs, so they involve networks. Many people who obtain these plans find the networks to be limited. Thus, it’s critical to make sure your preferred practitioners are in-network if you choose an Advantage plan.

Some Advantage plans boast $0.00 monthly premiums. While the can seem appealing, be mindful that you will still have to pay your Part B premium in addition to the premium for your Advantage plan. If you are unsatisfied with your Advantage plan, keep in mind that you may opt to return to Medicare during a future Annual Enrollment Period and purchase Medigap if you qualify.

There are several different types of Advantage plans available:

  • PPO plans – Preferred Provider Organization
  • HMO plans – Health Maintenance Organization
  • SNP – Special Needs Plans
  • PFFS plans – Private Fee For Service
  • HMO-POS plans – Health Maintenance Organization- Point Of Service

If you’re dissatisfied with your Advantage plan, keep in mind that you may opt to return to Medicare during a future Annual Enrollment Period. At that time you can purchase a Medigap if you qualify.

Medicare Part D Definition

Part D of Medicare covers prescription drug medication. Prescription drug costs can add up quickly! This type of plan helps people with medications they need for health conditions. Most premiums will range anywhere from $15-$90 per month. Prescription drug coverage will cover mail orders as well as medications from the pharmacy. Factors such as the specific plan, the medications, and the pharmacy can influence the price.

Pharmacies have different pricing, so it’s essential to look for one that fits your needs and insurance. Before signing up for a Part D plan, make sure that any medications you take regularly are included in the plan’s formulary.

Bear in mind that although you might not think you need prescription drug coverage now, it’s better to have the coverage before you do need it. If you enroll in Part D late, you’ll need to pay a late penalty. There are many drug plans to choose from in each state. Have your agent help you determine which is the best plan for you.

Definition of Medicare Supplement Plans

Parts A and B don’t cover all health care costs. Luckily, Medicare Supplement plans can help fill those gaps. These plans can cover the costs of copayments, deductibles, coinsurance, and other out-of-pocket expenses.

There are several different Supplement plans available to beneficiaries. These Supplement plans’ cost depends significantly on the letter plan you choose, your location, age, and carrier. You must have Part A and Part B to obtain a Medigap plan.

FAQs

How is Medicare different from Medicaid?
Medicare is federal health care for people over 65 and those with disabilities. Medicaid is available on the state level, generally to those with lower incomes and pregnant women. It’s possible to be eligible for both programs.
What will Medicare pay for?
Medicare will pay for most procedures that are medically necessary. Cosmetic surgery purely for aesthetic purposes and most naturopathic treatments are two examples of what would not be considered medically necessary.
What's not covered by Medicare?
Parts A and B don’t include dental, vision, or hearing benefits. These can be obtained as ancillary policies or as part of an Advantage plan.

How to Learn More About Medicare

Hopefully, you now feel more familiar with the different parts of Medicare and what is included with each. We understand it can be overwhelming and confusing at first, which is why we're here to help you find the information you need for yourself or your loved ones.

Not only are we an online Medicare learning resource, but we're also able to help you find the best rates for the above types of coverage! To receive an online premium comparison, give us a call at the number above. Or, complete our online rate form to view rates. This service is free and we have helped countless people find the best coverage. We look forward to doing the same for you.

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Lindsay Malzone

Lindsay Malzone is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.

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