Medicare 101

Medicare is a program sponsored by the federal government to help American citizens cover certain healthcare costs. This means that the program doesn’t cover entire everything as far as healthcare is concerned.

For instance, Medicare doesn’t cover routine dental care or long-term care.

Recent surveys have shown that most people do not fully understand Medicare despite being enrolled in it. Indeed, Medicare can be confusing and difficult to understand con considering the various plans it has.

Although It is not a must to know everything about Medicare, it is important to understand the basics for your own benefit.

There are basically four parts of Medicare. Each part has its own qualification requirements and covers certain health services. But there are services that are found in more than one part. Often times people find themselves needing to look their number up, replace a medicare card or even find out their Medicare number. This might be overwhelming if you need to do this for a first time. If you want to find out your Medicare number you can do this by visiting your MyMedicare account.

Below is a detailed discussion of each part:

Part A: Medical insurance

Part A of the Medicare program basically covers hospitalization. Anyone who enrolls in Medicare receives Part A automatically. There is no payment of premiums for anyone in this plan.

Part A covers services such as inpatient care, hospice care, skilled nursing facilities, healthcare services in a denominational health facility, and home healthcare services. This may sound simple but there are more specific details about the provision of each service.

For example, in-home hospice care is covered by the Part A plan while a stay in the hospice facility is not covered by the program. Besides, a deductible is often applied if you are hospitalized and stay in for over 60 days in the hospital.

Part B

Part B of the Medicare program covers a wide range of healthcare services. Some of the services include medical equipment, outpatient procedures, doctor’s visits, cardiac rehabilitation, cancer treatment, mammograms, and the purchase of blood.

If you already have creditable coverage from a different source like an employer, then there’s no need for you to enroll again for Part B. But if you don’t have coverage and fail to enroll in this plan, then you may be required to pay a penalty when you enroll later.

With Part B, you are supposed to pay a monthly premium of $148.50. This amount can still be recouped from your Social security payments if you are attained the age of retirement. The yearly deductible for this plan is currently at $203.

You will only pay 20 percent of the cost of service approved by Medicare after meeting the deductible – as long as the healthcare facility attending to you accepts Medicare.



What is not covered by Part A and Part B plans?

One of the most important services missing in the original Medicare program is long-term care. For example, if you have a chronic illness that needs ongoing long-term medical assistance, then Medicare won’t cover any costs related to that.

Nonetheless, both plans will cover the costs of seriously ill patients moved from an intensive care unit. Some of the services covered nay include respiratory therapy or head trauma treatment.

Part C

Part C is also referred to as Medicare advantage. It is basically an alternative to the original Medicare coverage. The coverage usually consists of a combination of Part A, Part B, Part D (drug prescription), and several other healthcare services.

Medicare Advantage is offered by private insurance companies approved by Medicare. They are the ones that receive Medicare payments from the federal government for the healthcare on your behalf.

You can either pay or not pay extra premiums for Part C – based on the plan you are enrolled in. Essentially, you don’t have to register for Medicare Advantage. But many people prefer it instead of paying for different plans separately.

Part D: Prescription Drugs

Part D is a Medicare program that covers prescription drugs. It is largely provided by private insurers. Part D is usually included in the Medical Advantage plan (Part C) and is optional to the public.

You may be required to attain an annual deductible for your plan to be able to cover prescription drugs. Some of Part D plans also have co-payments.

It is also important to note that Part D also has what is called a coverage gap – a temporal restriction on what can be covered by the drug plan.

The coverage gap is popularly known as the “doughnut hole”. The gap takes effect immediately you have spent beyond a certain amount of money allocated to you.

In a nutshell, Medicare plays a big role in the country’s healthcare system. It is important to understand how it works in order to make the most out of it.