Insurance can be pricey, and trying to figure out all of the healthcare options available to you can be exhausting and frustrating.
Whether you’re new to Medicare or just interested in staying informed, here’s what you need to know about the basics of this federal health insurance program.
Medicare is a government-funded health insurance program that provides medical coverage for people over the age of 65. You can also be eligible for Medicare if you:
- have a disability and have been receiving social security disability benefits for two years
- have a disability pension from the Railroad Retirement Board
- have Lou Gehrig’s disease (ALS)
- have kidney failure (end-stage renal disease) and receive dialysis or have undergone a renal transplant
This health insurance can be used as primary insurance or as supplemental, backup coverage. Medicare can be used to help pay for medical care and long-term care, but it might not cover all your medical expenses.
It’s funded by taxes and, in some cases, premiums that are taken out of your social security checks.
You’ll automatically be enrolled in the program if you’re already receiving social security benefits. If you aren’t already receiving benefits, you should contact the social security office three months before your 65th birthday to enroll.
You can apply for Medicare coverage at http://www.socialsecurity.gov/medicare/apply.html.
Medicare is designed to cover your essential medical needs, such as hospital stays and doctor visits. The program is composed of four parts: Part A, Part B, Part C, and Part D.
Part A and Part B are sometimes called “classic Medicare.” These two parts provide for the majority of essential services.
Part A (Hospital)
This section of Medicare covers your hospital care, including various hospital-related services. According to Medicare.gov, most of your care related to treatment is covered by Part A if you have to go to the hospital as an inpatient. Part A also covers hospice care for those who are terminally ill.
For most people with a modest income, there will be no premiums. People with higher incomes may have to pay a small amount monthly for this plan.
Part B (Medical)
This area of Medicare covers your general medical care. Part B covers outpatient care that you may need to stay healthy, including:
- a large portion of preventative services
- medical supplies (known as durable medical equipment, or DME)
- many different types of tests and screenings
- mental health services
Visit www.medicare.gov for a complete list of covered services under Part B. There is typically a premium for this section of Medicare coverage, based on your income.
Part C (Medicare Advantage)
Part C is not actually a separate medical benefit. It’s a provision that allows approved private insurance companies to provide insurance plans to people who are enrolled in Parts A and B. Part C plans are also known as Medicare Advantage plans.
These cover all the benefits and services that parts A and B cover. They also usually offer extra benefits, such as prescription drug coverage and some extra services. Medicare Advantage plans usually cost extra and payments or premiums are deducted from your social security check.
Part D (Prescription Drugs)
This part of Medicare covers prescription drugs. The cost or premium for this plan depends on your income, and your copayments and deductible depend on the type of medications you need.
While Medicare Parts A and B provide coverage for many services, not every medical situation is covered. For example, long-term care is not considered part of Medicare. If you need long-term care, you can find coverage under Part C (Medicare Advantage plans) or Medigap plans, which are supplemental health policies.
Prescription drugs aren’t covered if you only decide to choose Parts A or B. It’s a good idea to either enroll in Medicare Part D if you need to cover your prescriptions, or to choose Plan C, which has plans that cover some drug prescriptions.
Knowing which plans are right for you depends on your income, overall health, age, and what kind of care you will need. It’s best to read through the services and plans carefully and choose the plans that work best for you.
Enrollment periods are limited for some plans, so be sure you sign up so you don’t have a gap in coverage.
If you’re concerned about whether your desired service is covered by Medicare, you can speak ask your doctor, search the Medicare Coverage Database online at www.cms.gov/medicare-coverage-database/, or contact Medicare at 1-800-MEDICARE (1-800-633-4227).