Understanding Medicare

Medicare is a government health insurance program that pays for the first 80% of medical costs for eligible participants. The remaining 20% of the cost of treatment or healthcare is covered by the patient, either out of pocket or through a supplemental insurance plan.

Medicare has four parts: A, B, C and D.

Medicare Part A

Medicare Part A is hospital insurance and is premium-free for most people. Most individuals become eligible for Medicare Part A as soon as they turn 65. Medicare Part A helps to cover:

  • inpatient hospital care
  • care in critical access hospitals
  • care in skilled nursing facilities (following a three-day minimum hospital stay during which the condition being treated was diagnosed)
  • hospice care
  • some home healthcare

It is important to note that under Medicare Part A, the maximum hospital or facility stay per ailment is 100 days. The first 20 days are covered by Medicare; the following 80 days require a co-pay.

Medicare Part B

Medicare Part B is optional medical insurance that is paid on a monthly basis. You may sign up for Medicare Part B during the 7 month period beginning 3 months before you turn 65. Medicare Part B helps to cover:

  • doctors' services, including x-rays, laboratory tests, certain vaccinations, ambulance transportation, etc.
  • outpatient care
  • physical and occupational therapy
  • some home health services
  • durable medical equipment, including canes, walkers, wheelchairs, etc. prosthetics and orthotics
  • surgical dressings
  • therapeutic shoes and inserts

It is important to note that in order for these services and supplies to be covered by Medicare Part B, they must be deemed medically necessary. Additionally, it is also important to recognize that Medicare Part B covers 80% of the actual charge or the calculated fee schedule amount for the item or service (whichever is lower), minus any unmet deductible, while the individual is responsible for covering 20% of the actual charge or the calculated fee schedule amount for the item or service (whichever is lower) plus any unmet deductible.

Medicare Part C

Medicare Part C is also known as a Medicare Advantage Plan. It combines elements of Part A, B and D coverage and is managed by private insurance companies that have been approved by Medicare.

Medicare Part C helps to cover medically necessary services, but is sometimes more cost-effective than having Part A and Part B Medicare coverage. Depending on the Medicare Part C plan you choose, your copays, coinsurance and deductibles will vary.

Medicare Part D

Medicare Part D provides prescription drug coverage, helping to lower prescription costs and protect eligible individuals from increased prescription costs in the future.

Medicare Part D offsets the cost of drugs that are prescribed to an individual by a doctor or specialist.

What Are the Basic Qualifications for Medicare?

In order to qualify for Medicare, you:

  • must be a legal resident of the United States for the past 5 years, and
  • must be 65 years of age or older and eligible for Social Security, or
  • may be under 65 with a specified disability, or
  • may be any age with End-Stage Renal Disease

Learn About Medicaid

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