Medicare is a federal health insurance program in the U.S. that covers eligible individuals aged 65 and older and younger individuals with disabilities or end-stage renal disease. This article explores the basics of Medicare, including its various parts—Part A, Part B, Part C, and Part D. It also delves into the range of medical services, hospital care, prescription drugs, and preventive services that each part covers.
Eligibility for Medicare
To be eligible for Medicare, an individual must be a U.S. citizen or a permanent legal resident for at least five years and be at least 65. Individuals under 65 with disabilities may also qualify, usually after a two-year waiting period if they receive Social Security disability insurance.
However, individuals with end-stage renal disease are enrolled automatically. Those with amyotrophic lateral sclerosis (ALS) become eligible from the month disability begins.
Medicare Part A – Hospital insurance
Medicare Part A covers inpatient care in hospitals or skilled nursing facilities, hospice care, and some home health care, excluding custodial or long-term care. It has a deductible of $1,600 and coinsurance, which requires patients to contribute a portion of the expenses.
Most individuals would have no premiums for Medicare Part A if they or their spouse paid Medicare taxes for a minimum of ten years. However, if they do not qualify for premium-free Part A, it is still available at a higher monthly premium. The monthly premiums for Part A can be as high as $506 per month.
Medicare Part B – Medical insurance
Medicare Part B covers doctor visits, medically necessary services, and supplies. This includes preventive services, ambulance services, durable medical equipment, mental health coverage, and select outpatient prescription drugs.
Enrolling in Medicare Part B requires a monthly premium starting at $164.90. Higher premiums apply to individuals with adjusted gross incomes over $97,000 and married couples filing jointly with AGIs over $194,000. Part B also has a $226 deductible; after that, patients usually pay 20% of the Medicare-approved amount for services and supplies.
Medicare Advantage – Medicare Part C
Medicare Advantage, or Medicare Part C, is a type of health plan offered by private insurance companies. It combines the benefits of Part A, Part B, and often Part D (prescription drug coverage). Medicare Advantage, or Medicare Part C, is a private health plan combining Part A, Part B, and often Part D benefits. Individuals pay their Part B premium and possibly an additional insurer premium.
Some plans have $0 premiums, including extra coverage for vision, hearing, and dental care. Unlike Original Medicare, Advantage plans have annual out-of-pocket limits, limited coverage areas, pre-authorization requirements, and copays/coinsurance for most services.
Medicare Part D – Prescription drugs
Medicare Part D helps with the cost of prescription drugs, including generic and brand-name medications. It’s provided by private insurance companies that require a monthly payment averaging around $31.50. People with higher incomes pay higher premiums.
Medigap
Medigap, or Medicare Supplement Insurance, provides additional coverage from private insurers to help individuals pay for costs not covered by Medicare Parts A and B. This includes deductibles, coinsurance, and some international healthcare.
However, Medigap does not cover long-term care, prescription drugs, dental, vision, hearing aids, or private nursing care. Individuals must have Medicare Parts A and B to purchase a Medigap policy.
