What is Medicare?

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What is Medicare?

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Medicare

Medicare can be confusing.  We developed this page in order to provide foundational information about the basic parts of Medicare. When you’re finished, make sure to head over to our Medicare and You page to get the latest official handbook.

What is Medicare?

Medicare is the federal government health insurance program that provides coverage for people 65 year old or under; under 65 years old and have Social Security Disability Insurance (SSDI) for a certain duration of time, or under age 65 and have End-Stage Renal Disease.

What are the parts of Medicare?

Medicare is broken into 4 parts.  Parts A, B, C, and D.  Each of these parts will provide health insurance coverage in a unique way.

Medicare Part A

Part A is your Hospital Insurance that helps cover some of your health care costs.

What does Part A cover?

  • Your inpatient care in a hospital.
  • Your care in a skilled nursing facility.
  • Hospice care.
  • Home health care.

Medicare Part A Benefits

The following is a breakdown of your Medicare Part A benefits. It shows you what Medicare pays. You are responsible for the remaining costs unless you have a Medicare Supplement plan to cover these expenses.

Part A Benefits

Services

Medicare Pays

First 3 pints

$0

Additional amounts

100%

Services

Medicare Pays

First 60 days

All but $1408

61st through 90th day

All but $352 a day

91st day & after (60 Reserve Days)

All but $704 a day

After Reserve (Additional 365 Days)

$0

Beyond the Additional 365 Days

$0

Services

Medicare Pays

First 20 days

All approved amounts

21st through 100th day

All but $176 a day

91st day & after (60 Reserve Days)

All but $704 a day

101st day and after

$0

Services

Medicare Pays

Must meet Medicare’s requirements. Including a doctor’s certification of terminal illness.

All but very limited copayment coinsurance for outpatient drugs and inpatient respite care.

*When your Medicare Part A hospital benefits are exhausted, the Medicare Supplement insurer will stand in place of Medicare. Your Medigap plan will pay whatever amount Medicare would pay for up to the 365 days as provided in your policy’s Core Benefits. During this time the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid.

what does medicare part a cover

Medicare Part B

Part B is your Medical Insurance that helps cover some of your costs.

What does Part B cover?

  • Doctor and related health care provider services.
  • Outpatient care.
  • Home health care.
  • Durable Medical Equipment.
  • Some health preventative services.

Medicare Part B Benefits

The following is a breakdown of your Medicare Part B benefits. It shows you what Medicare pays. You are responsible for the remaining costs unless you have a Medicare Supplement plan to cover these expenses.

Part B Benefits

Services

Medicare Pays

First 3 pints

$0

Next $198 of approved amounts

$0

Remainder of approved amounts

Generally 80%

Services

Medicare Pays

First $198 of approved amounts

$0

Remainder of approved amounts

Generally 80%

Part B Excess Charge

$0

Services

Medicare Pays

Tests for diagnostic services

100%

Services

Medicare Pays

First $250 during 1st 60 days

$0

Remainder of charges up to a a lifetime max of $50,000

$0

Medicare Part B

Parts A and B Benefits

Both Part A and Part B benefits help cover the costs of home health care – Medicare approved services. 

Below is a breakdown of benefits. It shows you what Medicare pays. You are responsible for the remaining costs unless you have a Medicare Supplement plan to cover these expenses.

Medicare Approved Services

Medicare Pays

Medically necessary skilled care & medical supplies

100%

Durable medical equipment

First $198 of Medicare approved amounts.

$0

Durable medical equipment

Remainder of Medicare approved amounts.

80%

Medicare Part C

Part C is also known as Medicare Advantage (MA) or (MAPD).

What does Part C cover?

  • Your Part A & B coverage is now managed and run by a Medicare approved insurance company and not original Medicare.
  • You are not automatically placed in a Part C (Medicare Advantage) plan.  It is a choice to be made by you to join a Part C or Medicare Advantage plan.
  • Typically includes Part D (Medicare prescription drug coverage) as part of the plan.  This is known as MAPD (Medicare Advantage with Part D).

Medicare Part D

Medicare Part D is your coverage for Medicare prescription drugs.  

What does Part D cover?

  • Part D is managed and run by private insurance companies that are approved by Medicare.
  • You are not automatically placed into a Part D plan.  Just like Part C, it is a choice to join a Part D plan.
  • Part D plans are designed to help cover prescription drug costs.
  • Finding the right Part D plan may help protect against increasing drug costs in the future and lower your prescription drug costs.

What about Medicare Supplements?

Medicare pays roughly 80% of your Part A and Part B medical costs and you’re responsible for the remaining 20%. Medicaid are not the same thing.

Medicare supplement insurance plans are there to help cover that 20%. Medicare supplements have nothing to do with Part C (Medicare Advantage) or Part D.  A Medigap plan is the same as a Medicare Supplement plan — there is no difference.

You will want to get a Part D drug plan if you choose to purchase a Medicare Supplement to help with drug costs.

Please remember that when you become eligible for Medicare, you can opt for either a Medicare Supplement or a Medicare Advantage plan (Part C).  

You are not allowed to have both.

Overwhelmed by Medicare?

We know that Medicare can be confusing.  We also know that everyone’s situation is different. That’s why we’re here to help. Schedule your free 30-60 minute consultation now!

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