Medicare
What is Medicare?
Medicare is a government insurance program offered to people 65 years or elderly and people with certain disabilities, such as End-Stage Renal Disease. It assists elder people with aid for medical, vision, dental, hospital and other health related costs.
How does it work?
There are two types of Medicare: Original Medicare and Medicare Advantage .
Original Medicare allows you to go to any doctor and facility that accepts Medicare. This program only covers hospital and medical costs up to 80%, which falls into the Part A & Bof Medicare. There is no limit to what you pay out of pocket. Original Medicare only covers a certain amount of days in the hospital or a facility. As well, Original Medicare rarely covers any out of country medical emergencies.
Medicare Advantage also known as part C & D can cover dental, vision and prescriptions drugs with also covering hospital and medical costs. This Unlike Original Medicare, Medicare Advantage has an out-of-pocket maximum, which means that after you hit your deductible maximum the plan starts to pay 100% of most of your bills. This plan might also cover out of country emergency medical bills, check with your provider about this.
Medicare Parts Explained
Medicare Part A
Hospital Coverage – Insurance that covers hospital expenses, hospice care, skilled nursing facility stays, rehabilitation facility stays, and also includes certain home healthcare services.
Does not guarantee that everything will be paid long term, there are restrictions that limit the length of time these services will be covered if, at all.
Medicare Part A Includes:
- Inpatient care in a hospital
- Skilled nursing facility care
- Nursing home care (inpatient care in a skilled nursing facility that’s not custodial or long-term care)
- Hospice care
- Home health care
Medicare Part B
Medical Coverage – Covers medical services which includes doctor’s visits, ambulances services, clinical research, durable medical equipment, mental health, limited outpatient prescription drugs.
Breaks into two sections: Medically necessary services & Preventive services
Medicare Part B Includes:
- Clinical research
- Ambulance services
- Durable medical equipment (DME)
- Mental health
- Inpatient
- Outpatient
- Partial hospitalization
- Limited outpatient prescription drugs
Medicare Part C
Medicare Advantage – an alternative to Original Medicare (Part A and B), offered by private insurance companies in agreement with the federal government.
Includes the same coverage as Medicare with additional supplemental benefits at higher monthly premiums in comparison to Original Medicare.
Medicare Part D:
Part D covers all prescriptions drugs that you might need. It is a separate program that only coverages prescribe drugs. It is important to select the best program for your needs.
- Tier 1—lowest copayment : most generic prescription drugs
- Tier 2—medium copayment: preferred, brand-name prescription drugs
- Tier 3—higher copayment: non-preferred, brand-name prescription drugs
- Specialty tier—highest copayment: very high cost prescription drugs
Who qualifies for Medicare Part D?
- Any person of 65 or older age
- People under 65 with certain disabilities can also qualify
- People with End-Stage Renal Disease (ESRD), which is the permanent kidney failure (either required to do dialysis or a kidney transplant)