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Medicare, America’s government health insurance program, was signed into law by President Lyndon B. Johnson on July 30, 1965. It provides health insurance coverage for persons aged 65 and older, for the disabled and for those with permanent kidney failure. Medicare is now assuming even more significance as the baby boomer generation is poised to turn 65, making millions of Americans eligible for Medicare. Medicare is often confused with Medicaid. They are not the same. Medicare was created in 1965 with the aim to provide health coverage to people on social security. Medicaid is also state-run, but meant to help with the hospital and medical coverage of people in poverty or with little resources. How Medicare Works Medicare is divided into four parts: A, B, C and D. Part A – Inpatient care in hospital, skilled nursing facility, hospice, and home health care
Part B – Medically necessary services like outpatient care, doctors’ services and screenings
Part C – Medicare Advantage Plan managed by private insurance companies
Part D – Prescription Drug Coverage • Part A covers hospitalization. You become eligible when you sign up for social security. It is free if you have signed up for social security and paid Medicare taxes when you were working. It also covers your spouse. You are eligible for Part A if: - You receive or are eligible to receive Social Security benefits; or
- You receive or are eligible to receive railroad retirement benefits; or
- You or your spouse (living or deceased, including divorced spouses) worked long enough in a government job where Medicare taxes were paid; or
- You are the dependent parent of a fully insured deceased child. Most people don’t pay Part A premium because they paid Medicare taxes while working. This is called "premium-free Part A." Medicare Part A works with a fee-for-service plan and you would be charged only if you are hospitalized. It covers hospital stays and emergency care. If a person had an accident and needed to be hospitalized, Medicare Part A would take care of this. Most Americans are eligible for Part A, but even if you are not, you can purchase it for a premium. You have the option of adding on B, C or D. • Part B covers doctor’s office visits, medical services and supplies including preventive screenings. For instance, if you have a fever and need to see a doctor, you would be covered by Part B. Usually, you are automatically enrolled in Part B when you have Part A. Part B is not free and you have to pay a monthly premium for these services. An individual has the option to cancel Part B coverage by contacting the Medicare Office. However, the cost of Part B is minimal and so it is advisable to keep it. • Part C is Medicare Advantage. This is optional Medicare coverage offered by private health insurance companies that are approved by Medicare. If you have Medicare Parts A and B, you can join a Medicare Advantage plan. With a Medicare Advantage plan, you can get the benefits of Parts A, B and D as well as some additional advantages.
Medicare Advantage plans include: - Medicare managed care plans
- Medicare preferred provider organization (PPO) plans
- Medicare private fee-for-service plans, and
- Medicare specialty plans Medicare Part C is not free. The health plans that private insurers offer work through hospital, doctor and other service provider networks that they are associated with. So you would get medical services only through these networks. Prescription drug coverage would also have to be paid for. • Part D is prescription drug coverage. You are eligible for Part D if you have Medicare hospital insurance (Part A), medical insurance (Part B) or a Medicare Advantage plan (Part C). When you opt to join a Medicare prescription drug plan, you have to pay an additional monthly premium for the coverage. To sum it up: Medicare Part A covers hospital stays and emergency care
Medicare Part B covers doctor office visits and routine health procedures
Medicare Part C is the Medicare Advantage plan run by private insurance companies. It combines the benefits of A and B and also gives the option to add D, if not already included
Medicare Part D is prescription drugs. A fee is usually charged for a drug care service or supply service.
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