Medicare is a federal health insurance program in the United States that provides coverage to people who are 65 years or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or transplant). In this article, we will explore how Medicare works and what it covers.
How Medicare Works
Medicare is made up of four parts: Part A (Hospital Insurance), Part B (Medical Insurance), Part C (Medicare Advantage), and Part D (Prescription Drug Coverage).
Part A covers inpatient hospital care, skilled nursing facility care, hospice care, and some home health care. Part A is premium-free for most people who have paid into the system through payroll taxes.
Part B covers outpatient medical care, such as doctor’s visits, diagnostic tests, and preventive services. Part B is optional and requires a monthly premium.
Part C, also known as Medicare Advantage, is a type of Medicare health plan offered by private companies that contracts with Medicare to provide all Part A and Part B benefits. Medicare Advantage plans often include additional benefits, such as dental, vision, and hearing coverage.
Part D provides prescription drug coverage and is also offered by private insurance companies.
What Medicare Covers
Medicare covers a wide range of medical services and supplies, including hospital care, doctor visits, diagnostic tests, and preventive services. It also covers some home health care, hospice care, and skilled nursing facility care.
Part A covers inpatient hospital care, including semiprivate rooms, meals, and general nursing services. It also covers care in a skilled nursing facility, such as physical therapy, if you have been hospitalized for at least three days.
Part B covers outpatient medical services, such as doctor visits, diagnostic tests, and preventive services, like flu shots and cancer screenings.
Part D covers prescription drugs and can help lower the cost of prescription medications.
Out-of-Pocket Costs
While Medicare covers a wide range of medical services and supplies, it does not cover everything. Beneficiaries are responsible for paying some out-of-pocket costs, such as deductibles, copayments, and coinsurance.
The amount of these costs can vary depending on the type of service or supply you receive. For example, you may have a copayment for each doctor’s visit or a deductible for each hospital stay.
Enrolling in Medicare
Most people are automatically enrolled in Medicare when they turn 65. If you are not automatically enrolled, you can sign up during the Initial Enrollment Period, which begins three months before the month you turn 65 and ends three months after the month you turn 65.
If you are under 65 and have a qualifying disability, you may be eligible for Medicare. In this case, you should contact Social Security for more information about enrolling in Medicare.
Conclusion
Medicare is a federal health insurance program that provides coverage to people who are 65 years or older, certain younger people with disabilities, and people with End-Stage Renal Disease. It is made up of four parts: Part A (Hospital Insurance), Part B (Medical Insurance), Part C (Medicare Advantage), and Part D (Prescription Drug Coverage). Medicare covers a wide range of medical services and supplies, but beneficiaries are responsible for paying some out-of-pocket costs, such as deductibles, copayments, and coinsurance. Most people are automatically enrolled in Medicare when they turn 65, but if you are under 65 and have a qualifying disability, you may be eligible for Medicare.