What’s Medicare?

Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).

The different parts of Medicare help cover specific services:

Medicare Part A (Hospital Insurance)

Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

You usually don’t pay a monthly premium for Medicare Part A coverage if you or your spouse paid Medicare taxes while working.

You generally pay a set amount for your health care (deductible) before Medicare pays its share. Then, Medicare pays its share, and you pay your share (coinsurance / copayment) for covered services and supplies. There’s no yearly limit for what you pay out-of-pocket.

Medicare Part B (Medical Insurance)

Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services.

Some people automatically get Medicare Part B and some people need to sign up for Part B. If you don’t sign up for Part B when you’re first eligible, you may have to pay a late enrollment penalty if you do not have other creditable coverage such as employer coverage.

You pay a premium each month for Part B. If you get Social Security, Railroad Retirement Board, or Office of Personnel Management benefits, your Part B premium will be automatically deducted from your benefit payment. If you don’t get these benefit payments, you’ll get a bill.

You generally pay a set amount for your health care (deductible) before Medicare pays its share. Then, Medicare pays its share, and you pay your share (coinsurance / copayment) for covered services and supplies. There’s no yearly limit for what you pay out-of-pocket.

Medicare Part C (Medicare Advantage Plans)

Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, you still have Medicare. You’ll get your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan and not Original Medicare.

Medicare Advantage Plans may also offer extra coverage.

Many Medicare Advantage Plans include prescription drug coverage. You can’t have prescription drug coverage through both a Medicare Advantage Plan and a Medicare Prescription Drug Plan.

Medicare beneficiaries change plans annually during the Annual Election Period, October 15th – Dec 7th . The new plan effective date is January 1st of the following year

Medicare Part D (prescription drug coverage)

Original Medicare does not include prescription drug coverage. Part D adds prescription drug coverage to Original Medicare

2 ways to get drug coverage: Medicare Prescription Drug Plan (Part D) or Medicare Advantage Plan (Part C)

If you decide not to join a Medicare Prescription Drug Plan (Part D) when you’re first eligible, or if you decide not to join a Medicare Advantage Plan (Part C) (like an HMO or PPO) or other Medicare health plan that offers Medicare prescription drug coverage, you’ll likely pay a late enrollment penalty unless you have other creditable prescription drug coverage, or you get Extra Help.

Medicare beneficiaries change plans annually during the Annual Election Period, October 15th – Dec 7th . The new plan effective date is January 1st of the following year

Medicare Supplement Insurance (Medigap)

A Medicare Supplement Insurance (Medigap) policy, sold by private companies, can help pay some of the health care costs that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles.

Some Medigap policies also offer coverage for services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then your Medigap policy pays its share.

Does not coverage prescription drug coverage (Part D)

Generally does not cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.

Source: www.medicare.gov

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