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Medicare: A Breakdown of the Basics

Medicare: A Breakdown of the Basics

| February 23, 2024

Are you approaching retirement age or dealing with a qualifying disability? Getting a grip on the complex world of healthcare coverage can be daunting, but if you meet certain criteria, you may be eligible for the Medicare health insurance program. Let's delve into the details and explore the different parts of Medicare to help you make informed decisions about your healthcare needs.



Who is Eligible for Medicare?

You may be eligible for Medicare if you meet any of the following criteria:

  • You are 65 years or older.
  • You are younger than 65 but have a qualifying disability.
  • You have End-Stage Renal Disease, regardless of age.


Understanding the Parts of Medicare

Medicare is divided into four parts, labeled A, B, C, and D, each covering specific healthcare services:


Medicare Part A: Hospital Insurance

  • Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care services. No monthly premium for most beneficiaries if they or their spouse have worked and paid Medicare taxes for at least 40 quarters (about 10 years).
  • Depending on how long you are an inpatient, there are deductibles and coinsurance.
  • Doesn’t cover custodial or longterm care if that’s the only type needed.


Medicare Part B: Medical Insurance

  • Covers outpatient care, physician services, and certain home health services.
  • Covers some things that Part A doesn’t, including occupational, physical, and speech therapy, as well as certain home healthcare services.
  • Requires a monthly premium, annual deductible, and coinsurance/copayments. Part B pays 80% of the final approved cost. You’re responsible for the balance after covering your annual deductible.
  • Provides coverage for services that are considered “medically necessary.” The healthcare provider must accept Medicare assignment.


Medicare Part C: Medicare Advantage

  • Offered by private insurance companies to eligible beneficiaries as an alternative to Original Medicare (Part A and Part B).
  • Provides the same coverage as Parts A and B, often with additional benefits like prescription drug coverage, dental, vision, and hearing care.
  • Requires adherence to the plan's network of healthcare providers in many instances.

 

Medicare Part D: Prescription Drug Coverage

  • Stand-alone plans available through private insurance companies or bundled with Medicare Advantage plans. 
  • Covers prescription drugs with varying coverage allowances, limits, and costs. 
  • Plans may have monthly premiums, deductibles, and copayments.

 

Choosing the Right Coverage

Let’s look at the basic differences between the Parts…

Original Medicare (Parts A and B)
offers flexibility in choosing healthcare providers. It requires supplemental coverage (Medigap) for additional benefits and cost-sharing.

Medicare Advantage (Part C)
bundles coverage under one plan with potentially lower out-of-pocket costs. It provides additional benefits beyond Original Medicare, but may have restrictions on healthcare providers.

Prescription Drug Coverage (Part D)
is essential for those requiring regular medications. It offers varying levels of coverage and costs depending on the plan.

 

Navigating the complexities of Medicare can seem like a daunting task, but understanding the different parts of the program is crucial in selecting the right coverage for your healthcare needs. Whether you opt for Original Medicare or choose a Medicare Advantage plan, weighing the benefits, costs, and restrictions can help you make an informed decision. Take the time to compare Medicare options available in your area to ensure you receive the coverage that best suits your needs and budget. Your health and well-being deserve nothing less.