What Is Medicare?
Medicare
Going into Medicare can be a great thing but first you need to know what it is and how it works for you. Who does Medicare cover? Is Medicare insurance and what does it cover? Do I have a network that I have to stay in? If you prefer to speak with someone about your questions you can call or text us at 866-319-5886.
Most people going into Medicare have these questions and although the questions are simple, the answers are sometimes complex or unique to the individual. Here we will go over all the information you will need to start your journey into Medicare.
So let’s start with the definition of Medicare. It is the federal health program for :
- People who are 65 or older
- Certain younger people with disabilities
- People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)
What are the Parts of Medicare?
Medicare consists of four major parts. These parts are defined by letters known as Part A, Part B, Part C and Part D. These parts are all very important for you to understand and how they work for you. Below we will go into detail as to what each part does.
What is Medicare Part A?
Medicare Part A is hospital insurance that will help cover your costs of any inpatient care and skilled nursing facility stays. It will also help cover your costs that come from hospice and home health care. This covers your stay in general and will not cover any medical procedures, medical services are covered by Part B.
Part A is usually premium-free for most people. You will get premium-free Part A if you have paid 40 quarters worth of Medicare taxes during your working years. If you have not paid at least that amount of time you will have to pay a premium that is determined by the Social Security Administration.
What is Medicare Part B?
Medicare Part B is your outpatient and medical services coverage. In a nutshell, Part B is going to cover everything else that you have covered that isn’t a charge for an inpatient stay. Part B is what will help you cover your costs for doctor visits, outpatient services, durable medical equipment and a variety of other medically necessary services you would have done when taking care of your health. Part B will also cover certain preventative services for you at no cost to you. Part B will cover 80% of all approved services after you have met the annual $185 deductible.
One important thing to know is that Part B is what will cover your cancer therapy costs and kidney dialysis treatments. These costs can be very expensive even after Part B pays its portion of the bill. This is why having a Medicare supplement is recommended by us.
There is a monthly premium for Part B that is determined by Social Security for each person. This cost changes from year to year and people in higher income brackets may pay more than those in lower income brackets. Your cost is determined by your adjusted gross income that is reported to the IRS from the recent years.
For a better understanding you can visit Medicare to see what your Part B premium will be.
What is Medicare Part C?
Medicare Part C is often referred to as the Medicare Advantage program, or private insurance. Not everyone will enroll into Part C. Only Part A and Part B are considered “Original Medicare”, which are the parts that everyone will enroll into with Social Security.
Anyone who wishes to enroll into Part C must also be enrolled into Parts A and B first. There are many different costs that will vary from plan to plan with Medicare Advantage plans when you are searching for a plan. No matter which plan you choose, even if it has a $0 premium, you will stay have to pay your Part B premium. Part C plans are location specific, which means you must live in the service area in order to get a certain plan. After you enroll into a Medicare Advantage plan you will have a network of providers to choose from that is determined by the private company you chose to have your plan with.
Part C is not mandatory for every person to have. You can stay with Original Medicare (Part A and B) and choose to get a Medicare supplement to help cover your costs. Many people choose to go this route because of the freedom that you get with a traditional Medigap Plan.
You don’t have to enroll in an Advantage plan or a Medigap plan. If you are unsure which is your best option we will be more than happy to help you figure out what will work for you and your needs.
What is Medicare Part D?
Medicare Part D is the program designed to help those in Medicare with their prescription drug coverage. Part D is the newest Part of Medicare and was introduced by the government in 2006.
So what does Part D cover? Does it cover all drugs?
Part D plans are run by private insurance companies and cover prescription drugs that you pick up at the pharmacy or order through the mail order programs. Drug plans are also location specific, meaning that you will be able to choose a plan that is available to you based on the zip code you live in.
You will have several plans to choose from and in most states you will have over 20 options to choose from. Many companies will have more than one plan available for you to choose from as well. How do you know which plan to choose? The best way to get the right plan is to get in touch with an agent, who can help you run a Part D analysis in Medicare’s drug finder program. Here the agent will go over your current prescription drug needs, enter them in and then will be able to help you see what your cost is based on your specific needs. There is not a one size fits all plan when it comes to the Part D drug plans.
You do not have to enroll into Part D when you enter Medicare but if you choose not to right away you may be penalized. If you have any questions about this please talk with an agent before you choose to not enroll in a Part D drug plan.
Medicare Vs Medicaid
Often people confuse Medicare and Medicaid. Again, Medicare is a federal program designed for people 65 and older, certain younger people with disabilities and people with End-Stage Renal Disease. Medicaid is a program that is designed to help those with low incomes. Some people will be able to qualify for both programs. In that case Medicare will be your primary and Medicaid will be your secondary coverage.
If you are unsure if you qualify for Medicaid you will want to check with your states Medicaid agency.
Need More Information on Medicare?
Are you still trying to understand how the benefits work for you? Maybe you would just like to verify your understanding of Medicare and how it works. We are here to help you understand it all, feel free to fill out the form below or give us a call or text us at 866-319-5886.