To define Medicare, it’s a national health insurance program for people ages 65 and older in the United States. Also, Medicare is for people with disabilities or end-stage kidney failure.
What exactly is Medicare, though? Are you even eligible? How can Medicare help you, specifically?
We’re here to help you understand just what Medicare is, what it does, and who it helps.
Define the Federal Medicare Program
The Centers for Medicare and Medicaid Services (CMS) is in charge of Medicare.
Medicare is for anyone over 65, under 65 on Social Security Disability for 24 months, or those under 65 with End-Stage Renal Disease.
Social Security and Medicare taxes that employees pay through their payroll finance this federal program.
Medicare Part A
To define Medicare Part A, it’s your hospital coverage. Part A is there if you need a nursing facility, short term respite care, social services, and inpatient hospital visits. Part A will cover the cost of a semi-private room.
Most patients aren’t responsible for a monthly premium with Part A, but they may have a deductible of $1408 in 2020.
Most people 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.
Medicare Part B
Medicare Part B helps cover doctor and specialist visits, labs, therapies, and so much more. Come 2020; monthly premiums will average around $144.60 for Part B.
Part B covers ambulance services and medical equipment. Also, Part B will cover 80% of costly treatments such as kidney dialysis as well as cancer therapy, part-time or intermittent home health care, and therapy treatments such as physical therapy.
Additionally, Part B 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.
People eligible for Part A can get Part B; you must enroll and pay a monthly premium.
Part C Medicare Advantage
To define Medicare Advantage, it’s a plan that offers more benefits than Part A and B. Coverage provides beneficiaries with benefits through private health insurance plans.
Some of the additional coverages may include vision and dental benefits.
People who obtain advantage plans usually find that they have a limited network when it comes to doctors.
Beneficiaries must pay premiums for Part B, and the Advantage plan; although, some may have a $0 advantage premium.
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
Always keep in mind that during a future Annual Enrollment Period, you may opt to return to Medicare and purchase Medigap if you medically qualify.
Medicare Part D
To define Medicare Part D, it’s prescription drug coverage. Prescription drug costs can add up quickly!
This plan helps people with medications they need for health conditions. Monthly premiums for generic medicines are typically around $35.
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, as well as the pharmacy, can influence the price.
Pharmacies have different pricing, so it’s essential to look around for one that fits your needs and insurance.
To sign up for the Part D plan, you must pick a carrier and then enroll in that carrier’s drug plan.
There are many drug plans to choose from in each state. Have your agent help you determine which is the best plan for you.
Medicare Supplement Plans
Parts A and B don’t cover all health care costs; Medicare Supplement plans can help fill those gaps.
They can help cover the costs of copayments, deductibles, coinsurance, and other out-of-pocket expenses.
There are several different supplement plans available to beneficiaries; all include extra benefits to supplement Part A and B.
The cost of these supplement plans depends significantly on the letter plan you choose, your location, age, and carrier.
Define Medicare Beneficiary
A Medicare beneficiary is a person eligible for benefits through Parts A and B. Beneficiaries are United States residents.
These people must pay deductibles, applicable premiums, and coinsurances for services.
Beneficiaries can get benefits through Medicare and choose from a variety of Supplements. Also, if a Medicare Advantage plan is more suitable, that option is possible.
Define Medicare Eligible
Typically, Medicare is for people 65 and older. However, people under 65 with disabilities and those suffering from End-Stage Renal Disease may also qualify for coverage.
If you’re eligible, you may get premium-free Part A. Part B will have a premium, costs vary because of income.
Premiums can be an automatic withdraw from Social Security, Civil Service Retirement, or Railroad Retirement benefits.
When a beneficiary doesn’t take the benefits above, the Part B premium payment can be a quarterly schedule.
Medicaid is health insurance coverage available to low-income families, pregnant women, seniors, and people with specific disabilities.
Medicaid coverage determination is on a state basis; the funding is both state and federal levels. Unlike Medicaid, Medicare eligibility doesn’t revolve around income.
You can apply for Medicare Savings Programs; these programs help pay for your Part B premiums and help aid with drug plans.
You may apply within your state in office or online to see if you qualify for eligibility.
If a person qualifies for both Medicare and Medicaid, then they’re “dual eligible.” When dual eligible, almost all healthcare costs have coverage.
If a person is 65 or older, as well as having a low income, they might qualify for eligibility for both programs.
Define Medicare Tax
Medicare taxes help cover costs associated with the program. These taxes are withheld automatically from their employee’s paychecks.
Medicare’s tax rate is 2.9 percent, and employers withhold about 1.45 percent from each of their employee’s paycheck. Employers then contribute their portion.
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