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What is Medicare? Common Questions and Answers

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What is Medicare?

Medicare is the federal government insurance program for Americans age 65 and older.

Younger people with disability status as determined by the SSA, and people with End Stage Renal Disease or Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s disease) may also qualify.

Although Medicare is not free, it was created to help provide affordable health care coverage for older and disabled adults who may not have access to health insurance through employment.

Here are a few things to know before enrolling.

 

What is Medicare Part A?

Medicare Part A covers hospital and skilled nursing facility stays, home health visits, and hospice services. 

However, although, Part A covers many healthcare services and supplies, it does not cover everything. For example, you will likely pay a deductible for each hospital stay and coinsurance anytime you need to consult a physician or surgeon.

In addition, it requires coinsurance for extended inpatient hospital stays.

 

What is Medicare Part B?

Medicare Part B covers medically necessary and preventative services.

For example, durable medical equipment doctor visits, outpatient services, blood tests, X-rays, diabetic screenings, and some home health visits are usually covered by Part B.

Typically, these benefits are subject to a deductible and coinsurance.

However, you will pay nothing for most preventive services (e.g. prostate cancer screenings) if you go to a health care provider who accepts assignment.

 

What is Medicare Part C?

Medicare Part C, also called Advantage Plans, are plans offered by private companies approved by Medicare. 

These plans typically provide all of your Part A and Part B coverage plus some additional coverage benefits such as vision, hearing, dental, etc.

In addition, most of these plans will offer some type of prescription drug coverage.

 

What is Medicare Part D?

Medicare Part D prescription drug plans help enrollees pay for prescription drugs. These plans are offered by insurance and private companies that have contracted with Medicare.

In Part D, enrollees pay monthly premiums and share costs for prescriptions with costs varying by plan. Each Part D plan has a list of covered drugs, called its formulary. If your drug is not on the formulary, you may have to request an exception or pay out of pocket.

You must have Part A or Part B in order to join a Medicare prescription drug plan.

 

Who provides Medicare?

The CMS is the federal agency that runs Medicare. It is paid for through Social Security and taxes, premiums that enrollees pay and dedicated portions of the federal budget.

 

Is Medicare free?

Although the program aims to help older adults fund healthcare costs, it is not completely free. Each part (Part A, Part B, Part C, and Part D) has different costs. These costs come in the form of copays, coinsurances, monthly premium, and deductibles.

Unfortunately, the cost and rules for each plan will change from year to year.

 

Who qualifies?

Generally, you must be 65 or older to qualify for Medicare. However, you may also qualify if you’re younger with a disability or if you have End Stage Renal Disease and Amyotrophic Lateral Sclerosis. To see if you qualify, visit the US Department of Human and Health Services website.

 

How do I enroll?

When you turn 65, you will automatically be enrolled in Medicare Part A and B if you are receiving Social Security Benefits. Part A will cover hospital costs and Part B will cover doctor visits.

Unfortunately, if you want Part D prescription drug coverage, you will need to enroll yourself. But don’t worry, the process is easy. Just go to the Medicare website to compare plans and find one that fits your needs.

 

Does it cover coronavirus related illnesses?

Yes, officials have made some changes to the program’s rules and procedures to help enrollees cope with the needs caused by the Covid-19 pandemic. For example, insurance will cover the vaccine and test for COVID-19 at no cost.

Pharmaceutical manufacturers are distributing the vaccine to federally and state-approved locations to start the vaccination of priority groups. However, each state has its own plan regarding how residents will get vaccines and which groups will be vaccinated first.

You can find out more information on Covid-19 vaccines and testing sites in your area by checking your local health department’s website.

 

Where can I find out more about?

You can find a lot of great resources regarding which plan is right for you online.  For example, https://www.medicare.gov/ is a great resource if you want the most accurate and up to date information.

Additionally, talk to your doctor and pharmacist about which plan will best fit your individual needs.

These resources will help prepare you as the rules and costs for each plan change in the new year.

 

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