Seniors
Medicare Explained Simply
Assistance with health care has been a growing issue in the United States for years. Many individuals, especially seniors, find that they are unable to afford medical bills or insurance for coverage. This leaves them with some tough decisions. Too often, one must choose between good health and finances. There’s no middle ground. The Medicare program was developed by the government to help those who are eligible with their overwhelming health care bills.
There is a lot of information to process when considering Medicare. Knowing what Medicare is and how it works will help you choose the program that will best meet your individual needs. But as complicated as all that sounds, there’s a single key choice at the core of all your decision-making. Will you go with the Original Medicare plan, which is run by the federal government and consists of Parts A and B, or a Medicare Advantage plan (also called Part C) that is offered by a private insurer and approved by Medicare?
What is Medicare?
Medicare is a government health insurance program administered by the Centers for Medicare & Medicaid Services (CMS). Medicare is the largest Medicare Health Insurance Providers in the country, with around 40 million Americans participating. To be eligible you must be a citizen of the United States and meet certain requirements. If you are not a citizen of the United States, you can contact the Social Security Administration office to learn if you would be eligible.
Can you answer yes to at least one of the following statements?
- I am 65 years of age or older.
- I am under 65, but I have certain disabilities.
- I have End-Stage Renal Disease (kidney failure that requires a transplant or dialysis).
If so, then you are likely to be eligible for Medicare benefits.
Medicare Part A
Part A is hospital insurance provided by Medicare. Most people do not pay a premium for this coverage. Part A covers inpatient care in skilled nursing facilities, critical access hospitals, and hospitals. Hospice and home health care are also covered by Part A.
Medicare Part B
Part B is medical insurance to pay for medically necessary services and supplies provided by Medicare. Most people will have to pay a premium to receive this coverage. Part B covers outpatient care, doctor’s services, physical or occupational therapists, and additional home health care.
Medicare Part C
Part C also known as Medicare Advantage is the combination of Part A and Part B. The main difference in Part C is that it is provided through private insurance companies approved by Medicare. With this program, you may have lower costs and receive extra benefits.
Medicare Part D
Part D is stand-alone prescription drug coverage insurance. Most people do have to pay a premium for this coverage. Plans vary and cover different drugs, but all medically necessary drugs are covered. You can choose what drug plan will be best suited to your needs.
Do you have questions about Medicare when moving out of state or to another county?
If you reside within the United States (including the District of Columbia, the U.S. Virgin Islands, Puerto Rico, Guam, and the Northern Mariana Islands), you may maintain your Original Medicare, Part A & B coverage. Of course, you’ll want to notify your health-care providers about your move to another state, and arrange for transfer of your medical records.
You might also have a stand-alone Medicare Part D Prescription Drug Plan, and/or a Medicare Supplement policy, working alongside your Original Medicare benefits and Medicare Advantage Plans. See below for information about how address changes may affect these plans.
Retiree insurance
If you’re retired and have Medicare and group health plan (retiree) coverage from a former employer, generally:
- Medicare pays first for your health care bills
- Your group health plan coverage pays second
How your retiree group health plan coverage works depends on the terms of your specific plan. Your employer or union, or your spouse’s employer or union, might not offer any health coverage after you retire.
Medicare Providers
