Medicare is a health insurance program available from the United States Department of Health and Human Services. It is for people 65 and older, certain younger people with disabilities, and people with permanent kidney failure requiring dialysis or a kidney transplant, also called End-Stage Renal Disease (ESRD).
Medicare is an entitlement program, similar to Social Security. United States citizens earn the right to enroll by working and paying into the tax system for a minimum required period. Individuals may still qualify for Medicare benefits if they did not work the minimum amount of time, but they might have to pay more.
Medicare has four different components:
Medicare Part A
This covers skilled nursing facility care, hospital stays, hospice care, and some health care costs. For people who have worked at least ten years and paid into the Medicare taxes, typically they are eligible for a premium-free policy. Otherwise, if you will have to pay a monthly premium.
Part A Benefits typically do not cover the full amount of hospital bills, so members are usually responsible for a share of the cost. Before Medicare benefits can begin, you will have to pay a deductible. After that, you are covered for 100% of your costs for up to 60 days in the hospital or up to 20 days in a skilled nursing facility. For the time after that, you pay a flat amount up to the maximum number of covered days. Medicare Part A benefits cover some of the expenses for a total of 100 days in a skilled nursing facility and 90 days in a hospital. For times when you stay in the hospital for longer than 90 consecutive days, you are covered up to 60 “lifetime reserve days.” Members receive a lifetime total of 60 reserve days.
Medicare Part B
This part of Medicare is medical insurance. It covers non-hospital expenses like blood tests, routine visits to the doctor, diabetic screenings and supplies, X-rays, and outpatient hospital care. Members pay a monthly premium for this part of Original Medicare (Parts A and B). For people with higher incomes, the monthly cost may be higher. Medicaid, another government program, can help cover Medicare Part B premiums for people with low-incomes.
Beneficiaries in this program are usually held responsible for a portion of their total health care costs. Before Medicare Part B benefits kick in, beneficiaries pay a small deductible each year. After that, they generally pay about 20% of the bill when they visit a participating Medicare physician. Many lab tests and services that are requested by doctors are fully covered by Medicare.
Medicare Part C
Part C is often called Medicare Advantage, and it often includes every type of Medicare coverage in one health plan. Private insurance companies are contracted through the Centers for Medicare & Medicaid Services (CMS) to provide this option. It is meant to provide an alternative benefits package to Original Medicare plans. This plan is optional, but in order to receive Part C, members must already have Part A and B). The premium beneficiaries pay for Part B is still required for a Medicare Advantage plan.
Plan C members have the option to receive additional benefits, which vary depending on the insurance provider. Many of these benefits include prescription drug coverage. Some of these plans also have a lower deductible, and allow members to share a smaller percentage of the remaining costs after medical care. Certain health care services not covered by Medicare Part A and B may be covered under Part C. These services include: hearing aids, dental care, eye exams, or health care received while traveling outside of the country.
Medicare Part D
The final part of Medicare coverage is also optional. Part D covered prescription drug coverage. Unlike Part C, it is available as a stand-alone service through many private insurance companies. Monthly fees vary among insurers, and the cost-share of prescriptions depends on the specific plan you're enrolled in. These costs can be a percentage of the full drug cost (or “coinsurance”), a flat co-payment amount, or a deductible.
Learn More About Medicare Eligibility Options
If you are unsure whether you qualify for Medicare, or would like assistance choosing the appropriate plan, we encourage you to give us a call today. Our experienced staff will help you navigate the ins and outs of applying for Medicare, and will be there for you every step of the process.
Greenway & Associates is one of the leading independent insurance brokers in the Southern Colorado. We serve business owners and individuals throughout the area. For more information about our products and services, please give us a call at 719-542-1887 to reach out Pueblo office or 719-633-5366 to reach our Colorado Springs location.
We look forward to helping you construct a Medicare plan to fit your needs!