Medicare is the federally funded national health insurance program for people 65 or older, certain younger people with disabilities, and those with end-stage renal disease (permanent kidney failure requiring dialysis or a transplant). In addition, Medicare helps pay for some medical services for younger persons with permanent disabilities.
Part A covers the following:
Inpatient hospital care. If you are admitted to the hospital, and your doctor determines that you need to stay overnight, Medicare like Alignment Health Plan will pay for that stay. You might have a deductible (a set amount of money you have to pay) for each hospital stay.
Inpatient hospital care. If you are admitted to the hospital, and your doctor determines that you need to stay overnight, Medicare will pay for that stay. You might have a deductible (a set amount of money you have to pay) for each hospital stay.
Skilled nursing facility (SNF) care. If your doctor decides that you need skilled nursing care after leaving the hospital, Medicare will pay for it. Medicare must approve the SNF, you’ll have to pay for this care yourself. You might have a deductible (a set amount of money you have to pay) for SNF services.
Home health care. This includes physical therapy, occupational therapy, and speech therapy given in your home or other location of your choice. You might have a deductible (a set amount of money you have to pay) for each home health visit or series of visits.
The time you get benefits under Part A depends on how long you’ve been paying Social Security taxes. If you haven’t paid Social Security taxes for 40 quarters (about ten years), your hospital insurance will be limited to 60 days per benefit period.
Part B
Part B is your main health insurance coverage and pays for most of the cost of doctor visits, medical tests, and other outpatient care. This doesn’t cover everything, though. It has a deductible you must pay each year before coverage begins. Once you’ve met the deductible, you pay 20 percent of the Medicare-approved amount for covered services. You will be responsible for paying a monthly premium to help cover the cost of your coverage. The amount of your premium depends on whether you have a traditional fee-for-service plan or an alternative plan (such as an HMO or PPO). This premium can change every year. In addition to the monthly premium, most people with Part B are also responsible for deductibles, coinsurance, and copayments — just like with private health insurance plans. In other words, if you want to see a doctor or get any treatment covered by Medicare Parts A or B, it’s essential to know how much it will cost ahead of time. Part B may cover:
Doctor visits — Medicare pays 80 percent of the cost of an office visit with a primary care physician (PCP) or specialist who accepts assignment (when the provider accepts Medicare’s approved payment as payment in full). If you see a specialist who does not accept assignment, Medicare will pay 100 percent of the approved amount for up to 3 pints of blood or blood products during one visit. After that, you’ll have to pay 20 percent coinsurance for any additional blood or blood products covered by Part B.
Outpatient care: You pay nothing for outpatient care at hospitals, including emergency room visits; physical therapy; occupational therapy; speech therapy; radiology services (such as MRIs); certain eye exams; bone density scans for osteoporosis; kidney dialysis; chemotherapy administration or other cancer treatments not administered at a hospital; routine foot care; podiatry services; hearing aids and other medically necessary assistive devices; and long-term nursing home care.
Hospice care: You pay nothing for hospice care for terminally ill patients who are expected to live six months or less with their illness.
Part C
Part C is Medicare Advantage. With this plan, you can get your Part A, and Part B benefits through a private insurance company or the Original Medicare Plan. You can pick a Medicare Advantage plan that offers extra coverage like prescription drug coverage, dental and vision coverage, or gym membership discounts. The plans may also provide different levels of medical care or have different cost-sharing requirements. If you live in a rural area or have other special needs, you can choose a plan that will give you more flexibility in choosing doctors and other healthcare providers. Some common benefits of Medicare Advantage are:
Medicare Advantage plans provide many of the same benefits as Original Medicare, but they also include additional benefits such as: prescription drug coverage, dental and vision coverage, and extra health services (e.g., physical therapy).
Provider networks —All plans require you to use doctors and hospitals in their network of providers. You will pay less out-of-pocket for care received from these providers because they negotiate discounts with them. However, it may be harder for you to find specialists who participate in your plan’s network of doctors and specialists than if you had traditional fee-for-service.
Part D
Part D is a prescription drug plan that comes as part of Medicare coverage. It covers certain prescription drugs, including those administered in a doctor’s office. Private companies issue the Medicare Part D plan. You can choose from various plans with different costs and benefits. How Part D works:
To enroll in Part D, you must first enroll in Medicare coverage and sign up for the specific plan you want to use. You can then get any prescriptions filled at your local pharmacy or mail-order company based on your chosen plan.
It’s important to remember that not every medication is covered by Part D. Also, there may be restrictions on how much you have to pay out of pocket before your insurance kicks in — this varies depending on what kind of drug it is and which plan you’re enrolled in.
Certain regions offer cheaper care while others don’t, and prices can vary dramatically depending on how you receive your care. If you are eligible for Medicare in the United States, it might be worth looking into your options before settling into a long-term plan.
