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What You Need to Know About Medicare

What exactly is Medicare? It's a federal health insurance program for:

  • People 65 years of age or over

  • People with a disability

  • People under age 65 with certain disabilities, and people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or kidney transplant.

Medicare Part A:

Hospital Insurance - Most people don't pay a premium for Part A because they or a spouse already paid for it through their payroll taxes while working. Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits.

Medicare Part B: Physician Services (Medical) Insurance - Most people pay a monthly premium for Part B. Medicare Part B (Medical Insurance) helps cover doctors' services and outpatient care. It also covers some other medical services that Part A doesn't cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary. Prescription Drug Coverage: Most people will pay a monthly premium for this coverage. Starting January 1, 2006, new Medicare prescription drug coverage will be available to everyone with Medicare. Everyone with Medicare can get this coverage that may help lower prescription drug costs and help protect against higher costs in the future. Medicare Prescription Drug Coverage is insurance. Private companies provide the coverage. Beneficiaries choose the drug plan and pay a monthly premium. Like other insurance, if a beneficiary decides not to enroll in a drug plan when they are first eligible, they may pay a penalty if they choose to join later. You can be penalized if you don't choose a prescription drug plan.

Medicare Advantage Plans: These are Replacement plans. The insurer (i.e. United Healthcare) takes over your coverage and reimbursement. There are several companies you can sign up with. You still pay Medicare your premium and some of these plans have 0$ premium, you get added coverage for dental, vision, hearing and some other services. Instead of paying 20 % co-insurance (that you would pay with Medicare) you will pay, co-pays.

MediGap: These are supplemental plans that are in addition to your Medicare. These plans cost more but help with the costs that Medicare doesn't pay.

Below is a chart that shows the different Medicare Plans and what they include.

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