Please note the most detailed
and accurate information regarding Medicare can be found on
www.medicare.gov. The following information is intended to
offer a summary of Medicare and some of the options available.
Medicare is a federal health insurance
program that pays for a variety of health care expenses. It's
administered by the Centers for Medicare & Medicaid Services
(CMS), a division of the U.S. Department of Health & Human
Services (HHS). Medicare beneficiaries are typically senior
citizens aged 65 and older. Adults with certain approved medical
conditions (such as Lou Gehrig's desease) or qualifying permanent
disabilities may also be eligible for Medicare benefits.
Similar to Social Security, Medicare is
an entitlement program. Most U.S. citizens earn the right
to enroll in Medicare by working and paying their taxes for
a minimum required period. Even if you didn't work long enough
to be entitled to Medicare benefits, you may still be eligible
to enroll, but you might have to pay more.
Parts A and B are often referred to as
Original Medicare. Medicare Part C, or Medicare Advantage,
is private health insurance, while Medicare Part D offers
coverage for prescription drugs. The details below tell you
more about Medicare insurance plans, with an overview of the
The "parts" of Medicare
The types of Medicare programs are often referred to as Part
A, Part B, Part C, and Part D. Here's a rundown of what each
"Part" is about.
Medicare Part A
Medicare Part A is hospital insurance. Part A covers inpatient
hospital care, limited time in a skilled nursing care facility,
limited home health care services, and hospice care.
Most Medicare Part A beneficiaries don't
have to pay a monthly premium to receive coverage under this
part of Original Medicare; this is called "premium-free
Part A." Generally, if you've worked at least 10 years
(40 quarters) and paid Medicare taxes while you worked, you're
eligible for premium-free Part A. Otherwise, you pay a monthly
Medicare Part A typically doesn't cover the full amount of
your hospital bill, so you will probably be responsible for
a share in the cost. You will also have to pay a deductible
before Medicare benefits begin. Medicare will then pay 100%
of your costs for up to 60 days in a hospital or up to 20
days in a skilled nursing facility. After that, you pay a
flat amount up to the maximum number of covered days. Your
Medicare Part A benefits cover some of the costs for a total
of 90 days in a hospital and 100 days in a skilled nursing
facility. Medicare also covers up to 60 "lifetime reserve
days." These are days you stay in a hospital longer than
90 days in a row. You get a lifetime total of 60 reserve days.
Medicare Part B
Medicare Part B is medical insurance. Part B benefits cover
certain non-hospital medical expenses like doctors' office
visits, blood tests, X-rays, diabetic screenings and supplies,
and outpatient hospital care. You pay a monthly premium for
this part of Original Medicare. The fee can be higher for
people with high incomes. A different government program,
Medicaid, can help cover Medicare Part B premiums for low-income
Medicare Part B beneficiaries are usually
responsible for a portion of their health care costs. You'll
have to pay a deductible each year before your Medicare Part
B benefits kick in, and then you'll generally pay 20% of the
bill when you go to a participating Medicare doctor. Medicare
pays the full cost of many lab tests and services requested
by your doctor.
Medicare Part C
Medicare Part C, or Medicare Advantage, insurance often includes
every type of Medicare coverage in one health plan. It's offered
by private insurance companies contracted through CMS to provide
a Medicare benefits package as an alternative to Original
Medicare. Enrolling into a Medicare Advantage plan is optional,
but to obtain this private insurance, you must also have Original
Medicare, Part A and Part B. You also may have to continue
to pay your Part B premium if you have a Medicare Advantage
While Medicare Advantage plans are required
to provide all Medicare Part A and Medicare Part B benefits
(except hospice care), plans can also include different additional
benefits, which vary among the individual private health insurers.
Many Medicare Advantage plans include prescription drug coverage
known as Medicare Advantage Prescription Drug (MAPD) plans.
Some plans might have a lower deductible, while also allowing
you to pay a smaller share of the remaining costs. Medicare
Advantage plans may even cover certain health care services
that Original Medicare, Part A and Part B, does not cover,
like eye exams, hearing aids, dental care, or health care
received while traveling outside the United States.
Medicare Part D
Medicare Part D is optional prescription drug coverage. Medicare
Part D is available as a stand-alone prescription drug plan
through private insurance companies, and the monthly fee varies
among insurers. You will share in the costs of your prescription
drugs according to the specific plan in which you're enrolled.
Those costs can include a deductible, a flat copayment amount,
or a percentage of the full drug cost (called "coinsurance").
Medicare parts A&B are known as Original
Medicare. Medicare Part C and Part D are offered by private
insurance companies who have a contract with Medicare for
the delivery of services to Medicare beneficiaries.
Medicare Supplements also known as Medigap are plans offered
by private insurance companies. There are a number of different
plans each represented by a letter (Plan A, Plan B…………Plan
N). Each plan has a set of core benefits that are offered
no matter what plan a beneficiary chooses. Each plan has a
set of additional benefits that based on the needs of the
beneficiary may or may not make sense for them.
Medicare Supplements are intended to work
with Original Medicare as a supplement to the basic benefits
offered through Part A and Part B.
Whatever option an eligible beneficiary
chooses there are decisions that need to be made and in most
cases a careful review of each beneficiaries situation is
advisable so the appropriate plan or plans can be selected.