Understanding Medicare

If you are approaching your 65th birthday or may be eligible for Medicare due to certain disabilities, you may be wondering how health insurance under Medicare works. Here is a primer on Medicare that will give you basic information and, hopefully, answer some of your questions

What Is Medicare?

Medicare is health insurance for the following:

People age 65 or older

People under age 65 with certain disabilities

People of any age with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant)

The Different Parts of Medicare

The different parts of Medicare help cover specific services. Medicare has the following parts:

Medicare Part A (Hospital Insurance)

Helps cover inpatient care in hospitals

Helps cover skilled nursing facility, hospice, and home health care

Medicare Part B (Medical Insurance)

Helps cover doctors’ services, outpatient care, and home health care

Helps cover some preventive services to help maintain your health and to keep certain illnesses from getting worse

Medicare Part C (Advantage Plans) (like an HMO or PPO)

A health coverage option run by private insurance companies approved by and under contract with Medicare.  Includes Part A, Part B, and usually other coverage like prescription drugs

Medicare Part D (Prescription Drug Coverage)

A prescription drug option run by private insurance companies approved by and under contract

with Medicare and helps cover the cost of prescription drugs.

Your Medicare Coverage Choices

With Medicare, you can choose how you get your health and prescription drug coverage. Below are brief descriptions of your coverage choices. Section 2 has more details about these choices and information to help you decide.

Original Medicare

Run by the Federal government.

Provides your Part A and/or Part B coverage.

You can go to any doctor or hospital that accepts Medicare.

You can join a Medicare Prescription Drug Plan to add drug coverage.

You can buy a Medigap (Medicare Supplement Insurance) policy (sold by private insurance companies) to help fill the gaps in Part A and Part B.

Medicare Advantage Plans (like an HMO or PPO)

Run by private insurance companies approved by and under contract with Medicare.

Provides your Part A and Part B coverage but can charge different amounts for certain services. May offer extra coverage and prescription drug coverage, sometimes for an extra cost. Costs vary by plan.

If you want drug coverage, you must get it through your plan (in most cases). You can’t use a Medigap policy with a Medicare Advantage Plan.

.Information provided as a service of Lawnwood’s Case Management Department. If you have additional questions or would like more information (please insert here what phone number or link you would like to include).
Excerpts from the CMS publication: Medicare and You 2010

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