Medicare
Health coverage for seniors
Medicare
Health coverage for seniors
What is Medicare?
Medicare is a government insurance program offered to people 65 years or older, to the elderly and to people with certain disabilities, such as End-Stage Renal Disease. Medicare assists older people with aid for medical, vision, dental, hospital and other health related costs.
How does it work?
There are two types of Medicare: Original Medicare and Medicare Advantage .
Original Medicare allows you to go to any doctor and facility that accepts Medicare. This program only covers hospital and medical costs up to 80%, which falls into the Part A & B of Medicare. There is no limit to what you pay out of pocket. Original Medicare only covers a certain amount of days in the hospital or a facility. As well, Original Medicare rarely covers any medical emergencies that occur out of the country.
Medicare Advantage also known as parts C & D can cover dental, vision and prescription drugs while also covering hospital and medical costs. Unlike Original Medicare, Medicare Advantage has an out-of-pocket maximum. This means that after you hit your deductible minimum, the plan starts to pay 100% of most of your bills. This plan might also cover out of country emergency medical bills. Please check with your provider about this.
Medicare Parts Explained
A
Medicare Part A
Hospital Coverage – This insurance covers hospital expenses, hospice care, skilled nursing facility stays, rehabilitation facility stays, and also includes certain home healthcare services.
It does not guarantee that everything will be paid long term. There are restrictions that limit the length of time these services will be covered if, at all.
Medicare Part A Includes:
- Inpatient care in a hospital
- Skilled nursing facility care
- Nursing home care (inpatient care in a skilled nursing facility that’s not custodial or long-term care)
- Hospice care
- Home health care
B
Medicare Part B
Medical Coverage – Medicare covers medical services, including doctor’s visits, ambulance services, clinical research, durable medical equipment, mental health services and limited outpatient prescription drugs.
This can be broken down into two sections: Medically necessary services & Preventive services.
Medicare Part B Includes:
- Clinical research
- Ambulance services
- Durable medical equipment (DME)
- Mental health services
- Inpatient services
- Outpatient services
- Partial hospitalization
- Limited outpatient prescription drugs
C
Medicare Part C
Medicare Advantage – This alternative to Original Medicare (Part A and B), is offered by private insurance companies in agreement with the federal government.
It includes the same coverage as Medicare with additional supplemental benefits at a higher monthly premium in comparison to the Original Medicare.
D
Medicare Part D:
Prescription Drug Coverage – This is a separate program that only covers prescribed drugs. Thus, it is important to select the best program for your needs.
- Tier 1—lowest copayment : most generic prescription drugs
- Tier 2—medium copayment: preferred, brand-name prescription drugs
- Tier 3—higher copayment: non-preferred, brand-name prescription drugs
- Specialty Tier—highest copayment: very high cost for prescription drugs
Who qualifies for Medicare Part D?
- Any person age 65 or older
- People under the age of 65 with certain disabilities
- People with End-Stage Renal Disease (ESRD), which is the permanent kidney failure (either required to do dialysis or a kidney transplant)
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