How It Works
One thing I hear when discussing health for seniors is that “Medicare is confusing.”
The purpose of this article will be to define some terms on the basics of Medicare. Health for seniors is an important issue, which is why the Federal government set up the Medicare system in 1965.
This program is often called “Original Medicare”. Medicare is the government health care program for people who are 65 or older, people who are under 65 with certain disabilities, and people of any age with end-stage renal disease.
For this article, we will focus specifically on health for seniors.
Medicare vs Medicaid
Medicare gets confused with Medicaid. Medicaid is a joint Federal and state program that helps pay medical costs if you have limited income and resources and meet other eligibility requirements. Some people qualify for both Medicare and Medicaid.
These people are “dual eligible”.
For more information on Medicare and Medicaid, visit www.medicare.gov. This is where you can get information on Medicare on-line, 24 hours a day. If you would like to speak with a Medicare person by phone, you can call the Medicare phone number 1-800-633-4227.
Medicare has four parts: A, B, C, and D
Medicare Part A is Hospital Insurance
It helps cover inpatient care in hospitals, as well as skilled nursing care, hospice, and home health care. While Medicare covers these areas of care, it often does not pay 100% of the possible costs in these areas.
To cover what Medicare does not pay, an individual can buy a Medicare insurance supplement. These plans are called Medicare supplement or Medigap policies.
Medicare Part B is Medical Insurance
It covers doctor’s services, hospital outpatient care, and home health care. It also covers some preventive services to help support your health and to keep certain illnesses from getting worse.
While Medicare covers these areas of care, it often does not pay 100% of the possible costs in these areas. To cover what Medicare does not pay, an individual can buy a separate Medicare supplement or Medigap policy.
Medicare Part C is Advantage Plans for Medicare
A Medicare Advantage Plan (like an HMO or PPO) is another Medicare health plan choice you may have as part of Medicare. Advantage Plans for Medicare are sometimes called “MA Plans” and are offered by private companies approved by Medicare.
If you join a Medicare Advantage Plan, the plan will offer all of your Part A (hospital) and all of your Part B (medical) coverage. In all types of Advantage Plans for Medicare, you are always covered for emergency and urgent care. Medicare Advantage Plans must cover all the services that Original Medicare covers except hospice.
Original Medicare covers hospice care even if you are in a Medicare Advantage Plan. Medicare Advantage Plans are NOT supplemental coverage.
Medicare Part D is Medicare Prescription Drug Coverage
Congress signed this coverage into law in 2003 and in 2006 a comprehensive drug plan was made available to the public.
Part D is a prescription drug option run by Medicare approved private insurance companies. The Part D Prescription Drug Plan (PDP) helps cover the cost of prescription drugs.
It may help lower your prescription drug costs and help protect against higher costs in the future.