What is Medicare?
Medicare is a federal government health insurance program administered by the Centers for Medicare & Medicaid Services (CMS). Medicare is the largest health insurance service in the country, with around 45 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.
What does Medicare Cover?
Medicare is divided into several parts simply known as Part A, Part B, Part C and Part D.
Medicare Part A – $0 Monthly Premium for most individuals. Medicare Part A provides coverage for hospitalization. It also covers a skilled nursing facility, hospice and home healthcare if certain conditions are met.
Part A: Hospital Confinement Insurance:
|Hospitalized||Medicare Pays||You Pay||Up To|
|1-60 Days||Most confinement after the required Medicare deductible||$1,316||$1,316|
|61-90 Days||All eligible expenses after patient pays the per-day co-payment, these are lifetime days||$329 per day||$9,870|
|91-150 Days||All eligible expenses after patient pays the per-day co-payment, these are lifetime days||$658 per day||$39,480|
|151-515 Days||Nothing||100% of all cost||Unlimited|
Part A: Skilled Nursing Confinement Insurance:
|Confined||Medicare Pays||You Pay||Up To|
|1-20 Days||All eligible expenses for the first 20 Days||Nothing||Nothing|
|21-100 Days||All eligible expenses after patient pays the per-day co-payment||$164.50 per day||$13,160|
|100+ Days||Nothing||100% of all cost||Unlimited|
Medicare Part B – $134.00 Monthly premium for most individuals (Unless you qualify for extra help through State/Federal programs – click here). Medicare Part B provides coverage for medically necessary services such as physician services, surgical services, outpatient care, testing, Durable Medicare Supplies supplies and doctor’s services. Part B also helps cover some preventive services to help maintain your health and to keep certain illnesses from getting worse.
Part B: Medical Insurance:
|Service||Medicare Pays||You Pay||Up To|
|Medicare approved charges||80%||20%||Unlimited|
|Excess charges||0% – Limited to 15% of approved amount||100%||NA|
|Outpatient||Coinsurance/Copayment amount varies according to service||Balance||Unlimited|
|Blood||80% after the first 3 pints||First 3 pints plus 20% additional||Unlimited|
|Home Health Care||100% of service; 80% of Durable Medicare Supplies Supplies||Nothing for Svc; 20% of Durable Medicare Supplies||Unlimited|
Medicare Part D – Neither Part A nor Part B of the traditional Medicare program includes prescription drug coverage. For people over 65 who rely on prescription medication to maintain their health, Medicare Part D provides prescription drug insurance for anybody who qualifies for Part A or Part B regardless of health status or income level.
In order to receive prescription drug coverage, you must enroll in a Medicare drug plan. Part D plans are offered by Medicare-approved private companies. Many Medicare Advantage plans cover both prescription drugs and medical care so long as you have both Part A and Part B. If you have traditional Medicare, you must enroll in a separate Part D plan if you want your medication covered.