Medicare: How Does It Work?

Today’s question: what is Medicare and how do I use it? The simple answer is, it’s government-sponsored health care for seniors and the disabled.

First created in 1965, Medicare was designed to provide medical coverage to people on social security. It’s often confused with Medicaid, which was created to provide medical care for those in poverty, but they’re not the same thing.

Learn more by watching this short video…

Medicare works a lot like health insurance except the government is the one reimbursing doctors and hospitals, not a private insurance company. You become eligible for Medicare when you turn 65, if you’re medically disabled before age 65, or if you have permanent kidney failure requiring dialysis or transplant.

Medicare is divided into several parts simply knows as Part A, Part B, Part C, and Part D. Medicare Part A is similar to health insurance that covers you against hospitalization due to catastrophic events. It can also help cover a skilled nursing facility, hospice, and home health care if certain conditions are met.

Medicare Part B provides coverage for medically necessary services such as outpatient care and doctors’ services. Part B also helps cover some preventive services to help maintain your health and to keep certain illnesses from getting worse.

Medicare Part C, otherwise known as a Medicare Advantage Plan, is another way to get benefits. It combines Part A, Part B, and sometimes Part D coverage, and is managed by private insurance companies approved by Medicare. These plans must cover medically necessary services.

Part C is more cost effective and often offers better benefits than having Part A and Part B together, even if you supplement A and B with additional coverage. However, plans can charge different copays, coinsurance, or deductibles for the services they offer.

Medicare Part D provides prescription drug coverage. This coverage may help lower prescription drug costs and helps protect against higher costs in the future.

Let’s say Gary, an active senior, is enjoying a parade. Suddenly, one of the elephant gets away and runs him over. He’s going to require some time in the hospital. Fortunately, Medicare Part A is there is to help offset his costs. If Gary had skipped the parade and instead went fishing and caught a cold, he wouldn’t need a hospital stay. But he would have to see the doctor. In that instance, Medicare Part B would pay for his doctor’s visit and Part D would help pay for the medicine he needs to get better.

So to sum it up, Medicare is managed by the federal government. Part A provides coverage for hospital stays and emergency care. Part B covers doctors’ visits and routine health procedures. Medicare Part C, also called a Medicare Advantage Plan, is like an HMO or PPO that is approved by Medicare and run by private companies. It combines the benefits of Part A and B, and also gives you the option of adding Part D coverage if it’s not already included. Part D helps lower your prescription drug costs, and you’re usually charged the fee for each health care service or supply you’d get.

So now you know. Until next time, stay smart and stay healthy!

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