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Understanding Medicare

Medicare is a government health insurance program that has four parts: A, B, C and D. The program was designed to help seniors and people with certain disabilities pay for healthcare in the United States.

doctors and patients

Medicare Part A

Medicare Part A is hospital insurance that 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
  • Skilled nursing facility care
  • Inpatient care in a skilled nursing facility
  • Hospice care
  • Some home healthcare

It is important to note that under Medicare Part A, the maximum facility stay per ailment is 100 days. The first 20 days are covered by Medicare; the following 80 days require a co-pay. If you need to stay longer than 100 days, those costs will come out of pocket.

Medicare Part B

Medicare Part B is a medical insurance in which you pay a monthly premium and yearly deductible. 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:

  • Doctor visits
  • Lab tests and X-rays
  • Emergency ambulance services
  • Mental health services
  • Durable medical equipment
  • Preventive services
  • Rehabilitative services

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.

Medicare Part C

Medicare Part C is also known as Medicare Advantage Plans, which are managed by private health insurance companies that have been approved by Medicare. These Medicare Advantage Plans provide all of your Medicare Part A and B coverage, as well as other benefits (such as vision, dental, hearing, etc.). You may have to see certain doctors and visit certain hospitals within a network to receive care.

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 certain health conditions, or
  • May be any age with End-Stage Renal Disease, or
  • Have ALS

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