Medicare is a government national health insurance program in the United States, begun in 1965 under the Social Security Administration and is now administered by the Centers for Medicare and Medicaid Services.
Each of the different parts of the Medicare plan covers specific services.
Medicare is considered a federal health insurance program for people under 65 living with certain disabilities, people who are 65 years or older, or people suffering from end-stage renal disease. The Medicare program provides basic coverage for parties struggling to pay for surgeries, hospital stays, and doctor visits. There are different enrollment periods where one is eligible to apply for a Medicare program.
Once you have signed up for the Medicare program, you are most likely to be enrolled in multiple plans or parts simultaneously. Below is information about the different parts of Medicare and how they come in handy in treatment programs:
Part A: Hospital Services
Medicare Part A is run by a federal agency known as the Centers for Medicare and Medicaid Services and is also classified under the original Medicare. With Original Medicare, the patient is qualified to visit any hospital or consult services from any doctor in the country so long as the institution or the medical practitioners are part of the Medicare program. If you consult services from a non-participating hospital or doctor, the out-of-pocket expenses are likely to be more expensive.
Part A is Medicare’s program for serious injuries that need observation from a health facility. General, this part covers:
- Home healthcare services are ordered by your doctor, like speech, occupational or physical therapies.
- A stay in an able health facility when the care required is short-term or has been ordered by the doctor.
- Hospice care if it has been certified by the doctor that you may die within six months.
You or your spouse qualify for no-premium coverage if you have paid your Medicare taxes for at least ten years; hence, most people can access Part A without paying for premium services. One also qualifies for the premium version of Medicare if they have retirement benefits from Railroad Retirement Board or Social Security.
Part B: Medical Services
Part B of Medicare covers lab tests, doctor visits, and other needed outpatient services. Medicare Part B may also cater to extra home services like home healthcare and durable medical equipment. It is also under the Original Medicare, which the government may manage, but this does not necessarily mean it is a free service.
With Part B, you pay for:
- A deductible
- A premium that increases with an increase in your income
- A coinsurance which amounts to 20% of the cost per medical service
Some of the treatments not covered by Medicare Part A and B include cosmetic surgeries, hearing aids, eye exams, cologuard and dental care. Also, prescription drugs are not inclusive of Part A and B; hence one needs to enroll in Medicare Part D to access that plan.
Part C: Medicare Advantage
If you need advanced medical treatments and are willing to part with the cash, Medicare Part C is ideal. The Medicare advantage is a typical replacement for Medicare Part A, and anyone with this privilege uses the plan’s identification card instead of the Medicare card while accessing Medicare services. However, you must have qualified for Medicare Part A and Part B to access the Medicare Advantage.
The Medicare Advantage is an all-inclusive package that includes services such as:
- Prescription drugs
- Meal deliveries
- Routine hearing
- Routine vision
- House cleaning for patients with asthma attack cases
Private insurance companies approved by Medicare sell these Medicare plans as an alternative way of getting your Medicare benefits. Once you have signed up for these Medicare plans, they must at least offer benefits offered in Par A and Part B. Also, private insurance companies add extra services such as a wellness program, adult care services, and transportation services to doctor appointments which is an ideal way of enticing more people to apply for the premium services.
In Medicare Part C, the government pays a certain fixed amount to the insurance company for your health care services, with the company setting your out-of-pocket costs. Some of the Medicare Advantage plans charge monthly premiums and once enrolled, you pay for it on top of the premium in Part B.
Part D: Prescription Drugs
Prescription drugs are covered in Medicare Part A and Part B but only under limited circumstances. The Original Medicare qualifies one for drug coverage in the Medicare Part D plan. In Medicare plan D, there is a range of prescription drugs and other specialized treatments like insulin and cancer. In each Part D, there is a list of covered drugs referred to as a formulary that organizes different levels of drugs and their varying costs.
Some of the crucial points in Part D include:
- To be enrolled in one, one must have enrolled for the Part and Part B coverage
- One does not need to have the Part D if they have already a drug coverage through the Medicare Advantage plan
- It is optional to have drug coverage. However, you may attract penalties in the future if you do not sign up for Part D during the first enrollment in the Medicare program.
Medicare Supplement Plans
These are plans not officially part of the Medicare package, but you may need them if you are already part of the Original Medicare. The Medicare Part A and B coverage leave you with high out-of-pocket costs like deductibles and coinsurance; hence the Medicare Supplement plans are a great option that helps cover the extra out-of-pocket costs.
Getting familiar with the Medicare plans helps you to settle on the most appropriate health insurance needs and discard the ones that do you no good. Once you understand how each of the Medicare parts works, you may not need to sign up for all of them and only go for what fits your budget. The Medigap package has ten different plans that are standardized and vary depending on what and how much each plan covers.
Every insurance company comes up with the Medicare Supplement Plans they want to sell. If you are signed in by more than one insurance company, your coverage has more than one party paying for it.