Medicare Basics
Medicare is a national social insurance program administered by the U.S. federal government. It guarantees access to health insurance for Americans ages 65 and older, people with disabilities, and people with End-Stage Renal Disease (ESRD).
An Overview of Medicare Parts
Medicare has four parts: A, B, C and D. Each is designed to cover specific services based on different healthcare needs and budgets.
Part A (Original Medicare)
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Hospital insurance that covers inpatient care in hospitals or a limited stay in a skilled nursing facility
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Covers hospice and home healthcare
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May pay up to 20% of total cost
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Does not include services like routine dental and vision care
Part B (Original Medicare)
- Medical insurance that covers doctors’ services, hospital outpatient care, and home healthcare
- Covers some preventive health services, such as screenings for heart disease, diabetes, and some types of cancer
- May pay up to 20% of total costs
- Does not include services like routine dental and vision care
Part C (Medicare Cost Plans)
- A type of HMO plan offered by private companies (like Scott and White) in certain areas of the country (like Texas)
- Members can see out-of-network providers and pay Part A and Part B coinsurance and deductibles
- May offer prescription drug coverage—if not, members can opt for Part D
- Members pay a premium directly to Medicare
- Can join any time it’s accepting new members
Part C (Medicare Advantage Plans)
- Optional coverage offered by private companies (members don’t pay a separate premium to Medicare)
- Covers all Medicare services, includes Part A, Part B, and sometimes Part D
- Have an out-of pocket maximum of $6,700 per year by law
A Medicare Special Needs plan is a type of Part C Medical Advantage Plan for those who qualify for both Medicare and Medicaid. Some Special Needs Plans are only for people who have a chronic condition. Other Special Needs Plans require the member be institutionalized.
Part D (Medicare Prescription Drug Coverage)
- Prescription drug coverage helping people with Parts A and B pay for prescription drugs