What is Medicare ?

Essential Medicare Facts you should know

Medicare Part A, Part B, Part C, Part D what are the differences, and do you know them? To ensure you get the most out of your Medicare plan, it is important that you understand the facts about the different parts of Medicare and how they apply to your Medicare Plan options and Benefits. 

Facts on the basic of Medicare 

Medicare is a health insurance program that pays for a variety of health care expenses, and is run by the federal government. Administered by the Centers for Medicare & Medicaid Services (CMS) , which is a division of the US Department of Health and Human Services (HHS), a majority of Medicare beneficiaries are senior citizens who are 65 years and older. A much smaller number of Medicare beneficiaries are Adults with specific illnesses or permanent disabilities.

Medicare, like Social Security, is an entitlement program. To earn access to the program, most US citizens and residents have to work enough time and pay their Medicare specific taxes. For people who have not worked enough time , they may still be eligible for Medicare, but have to pay a higher monthly premium. 

Medicare is made up of four different parts. There are Part A and Part B which are considered “Original Medicare”. Then there is Part C or Medicare Advantage, which is a private health insurance plan. Finally Medicare Part D is a stand alone portion of Medicare that specifically covers prescription drugs. Below are some more details about Medicare insurance plans, and the four different parts. 

Medicare and its “Parts”

Here are some specifics about the four main parts of Medicare, and what they do. 

Medicare Part A 

Part A under Medicare is for hospital coverage. It covers in-patient hospital care, very limited skilled nursing facility care, limited home health care services, and hospice care.

A majority of beneficiaries who have Medicare Part A will not have a monthly premium for this portion for this part of Original Medicare. This portion is called “premium-free Part A”. In most cases, if you have worked the minimum required years (10 years or 40 working quarters) and have paid the Medicare taxes through your work, then you should be eligible for Medicare part A without a premium. If you have not worked enough time, then you may have to pay a monthly premium 

Although Medicare Part A does cover your in-patient hospital care, it will not pay the full amount of your bill. This is because there are shared costs between Medicare and the beneficiary. Additionally, there is a deductible that the recipient must pay before Medicare starts covering hospital costs. Once the deductible is met then Medicare will cover 100% of a beneficiary’s costs for 60 days, if you are in a hospital or up to 20 days in a Skilled Nursing Facility.  Once these days have been exhausted then there is a flat amount up to a maximum number of days. Benefits under Medicare Part A cover some of the costs up to 90 days of hospitalization and 100 days in a skilled nursing facility. On top of these days, Medicare also covers 60 lifetime reserve days.  These days start being reduced for every day over 90 that you spend in the hospital, and over a lifetime a beneficiary can only receive 60 of these lifetime reserve days. 

Medicare Part B

Part B under Medicare is for medical insurance. These are primarily non hospital services like doctors visits, x-rays, blood tests, screenings and services that are received outside of the hospital. There is normally a monthly premium for Medicare Part B. The premiums for Medicare Part B for people with high incomes may be higher. If somebody has a lower income they may be eligible to apply for Medicaid, which is a different program than Medicare specifically designed to help people with limited resources and assets.

Medicare Part B will usually pay for 80% of the cost for outpatient medical services. This means that the Medicare Beneficiary is responsible for 20% of their healthcare services. This is on top of a minor deductible that renews every year. Medicare pays the full cost of lab tests and servicers that are requested by a doctor. 

Medicare Part C 

Medicare Advantage or Medicare Part C is usually an All in one Medicare Coverage Health plan. They are plans that are offered by private health insurance companies who contract with CMS to provide services that are covered under Medicare. They are an alternative way that beneficiaries can get their Medicare services. Medicare Advantage plans are optional and may not be available in all areas of the country and if somebody enrolls into a Part C plan they will normally need to continue to pay their part B monthly premiums. 

Medicare Advantage plans are required to provide all Medicare Part A and Part B covered services, with the exception of Hospice care, but in addition may offer a variety of extra benefits that are not covered by original Medicare. Of the main differences between Medicare advantage and Original Medicare is prescription drug coverage. Many Medicare Advantage plans automatically include prescription drug coverage.  Other services that Medicare Advantage plans cover are things like Eye exams, Hearing aids, dental care, and transportation. These things are not covered by Original Medicare 

Medicare Part D 

Lastly is Medicare Part D, which is the plan type that is only specifically for prescription drug coverage. It is available as a stand alone prescription drug plan or included in a Medicare Advantage plan. The monthly premiums vary from insurance company to insurance company and are only offered by private health insurance plans. If you have a Medicare Part D plan you will share the cost or your prescription drugs with the insurance company at preset amounts set by your insurance company. These costs can include deductibles, copays, and a percentage of the cost of your drugs. 

Prescription Drug Coverage is available through a Medicare Advantage Prescription Drug plan (MAPD) which is a Medicare Advantage plan that includes a Prescription drug plan or a stand alone Prescription drug plan or PDP, if there is one in your area. 

If you have low income and cannot afford medications it is possible to receive extra help through the Low Income Subsidy program that may help people pay for their prescription drug premiums, copays and coinsurance costs. 

We are the Covered California Enrollment Center, your place to get free assistance with your health insurance plan. We can assist you to sign up, enroll and update your private health Insurance, Covered California plan, Medi-Cal, Obamacare and Medicare insurances. Our California agency is certified by Covered California, to assist you in-person, over the phone or online in English and Spanish. 

We specialize in individual and family health insurance plans, Medicare, Medicare Advantage plans, Medicare Supplement (MediGap plans), Medicare Prescription Drug plans (Part D), as well as, Dental and Vision coverage. We can help you get enrolled into health insurance plans, compare healthcare options, provide required health coverage tax documents and review the plans that best fit your budget and healthcare needs.  

Call us today at 844-367-6555 for free assistance over the phone, visit our website at www.EnrollSocal.Com to make an appointment at our California Enrollment Centers Serving San Diego County, Los Angeles County and Imperial County.