Important Facts to Know about Medicare

Medicare is an essential program for older Americans, providing them with access to quality healthcare. It helps to cover the costs of doctor visits, prescription drugs, and other medical services. Medicare also provides important benefits such as hospice care and skilled nursing facility care. The bottom line is that Medicare is a vital safety net for seniors, and without it, many would be unable to afford the care they need.

What is Medicare?

Medicare is a national health insurance program in the United States, begun in 1966 under the Social Security Administration (SSA) and now overseen by the Centers for Medicare and Medicaid Services (CMS). It provides health insurance coverage to people who are 65 years of age or older, as well as to those with certain disabilities.

What Does Medicare Cover?

Medicare generally covers doctor’s visits, hospitalization, preventive services, durable medical equipment, and some home health care and hospice care. It does not cover long-term care, dental care, cosmetic surgery, or most prescription drugs.

How Does Medicare Work?

Medicare is funded by a combination of payroll taxes paid by workers and employers, as well as by premiums and surcharges paid by beneficiaries. In most cases, Medicare Part A (hospital insurance) is free, while Medicare Part B (medical insurance) requires a monthly premium.

Who Is Eligible for Medicare?

To be eligible for Medicare, you must be a U.S. citizen or legal permanent resident of at least five years, and you must either be 65 years of age or older or have been receiving Social Security Disability Insurance (SSDI) benefits for at least 24 months.

What Are the Different Parts of Medicare?

There are four parts to Medicare: Part A (hospital), Part B (medical services), Part C (Medicare Advantage Plans), and Part D (prescription drugs).

1. Part A covers inpatient hospital care, skilled nursing facility care, home health care, and hospice care.
2. Part B covers doctor’s visits, outpatient care, preventive services, durable medical equipment, and some home health care.
3. Part C is an alternative to original Medicare that includes Parts A and B, as well as often Part D. It is offered through private insurance companies approved by Medicare.
4. Part D covers prescription drugs and is offered through private insurance companies approved by Medicare.

What Are the Costs of Medicare?

Medicare Part A is free for most people. Medicare Part B has a monthly premium that is deducted from your Social Security benefits. The standard premium for Medicare Part B in 2023 is $170.10, but some people pay more depending on their income. Medicare Part C and D plans have premiums that vary by plan. You may also have to pay deductibles, copayments, and coinsurance for some services.

What Are My Options if I Have Medicare?

If you have Medicare, you can choose to receive your benefits through original Medicare (Parts A and B), a Medicare Advantage plan (Part C), or a Medicare Part D prescription drug plan. You can also enroll in a private supplemental insurance plan to help cover costs not covered by Medicare.

What Are the Different Types of Medicare Advantage Plans?

There are three types of Medicare Advantage Plans: Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Private Fee-for-Service (PFFS) plans. HMOs require you to use in-network providers, while PPOs allow you to see out-of-network providers, but you will pay more for doing so. PFFS plans give you the flexibility to see any provider that accepts the plan’s terms and conditions.

What Are My Options if I Have a Pre-existing Condition?

If you have a pre-existing condition, you may still be able to get coverage through a Medigap plan, a Medicare Advantage plan, or a Part D prescription drug plan. Just keep in mind, Medigap Plans can deny coverage for pre-existing conditions if there is no special enrollment period that allows them to get their coverage guaranteed. However, Medicare Advantage plans will NEVER deny coverage for pre-existing condition and neither will Part D plans.

What Are My Options if I Have Limited Income and Resources?

If you have limited income and resources, you may be eligible for Medicaid. Medicaid is a government program that helps pay for medical care for people with low incomes.

How Do I Sign Up for Medicare?

You can sign up for Medicare online at the Social Security Administration website, or you can call 1-800-MEDICARE (1-800-633-4227) to enroll.

Conclusion

Medicare is a vital social insurance program that provides health care coverage for millions of Americans. The program is especially important for seniors, who are more likely to have chronic health conditions and require more medical care than younger adults. Medicare also helps to keep families financially secure by helping to cover the costs of health care. If you are eligible for Medicare, sign up as soon as possible so that you can start taking advantage of all its benefits!