December 15, 2022

What is Medicare & What Does it Cover?

Medicare is an insurance program unveiled by the U.S. government; it is meant for people aged 65 and above. People below 65 and have disabilities are also eligible for this insurance coverage.

Medicare comprises numerous plans, and they cover different healthcare aspects. Some of these plans usually come at a cost. Since there are different Medicare plans, participants usually have more choices when it comes to coverage and costs.

Below, we’ll look into the different Medicare plans and what they cover.

  • Part A- usually covers hospital care
  • Part B- covers outpatient medical care and doctor appointments
  • Part C- offered by private insurance companies and covers benefits offered by part A and B
  • Part D- usually covers prescription drugs

Let’s delve further into all you need to know about each Medicare plan.

Part A

Also referred to as hospital insurance. Medicare Part A usually covers the costs that arise when you’re admitted to a hospice or hospital; this plan also covers different health services. When most people reach 65, they’re enrolled in Medicare Part A automatically.

You’ll pay for the following for Medicare part A:

  • Coinsurance- After meeting your deductible, this is the Part whereby you’ll have to pay for the additional cost.
  • A deductible annually- this is the Part you pay first before Medicare can begin paying for your medical bills.

If you and your spouse have social security benefits, there is no need to pay the monthly fee if you’re interested in Medicare Part A since you’ll be enrolled automatically.

If you’re not receiving social security benefits since you don’t qualify or are still working, you need to contact the local security office. You’ll also be required to remit a monthly fee if you’re interested in Medicare part A.

Part B

Also known as medical insurance, Medicare part B usually covers outpatient care. For example, it can pay for tests, a visit to a medical practitioner, and preventative care such as vaccines.

It also covers certain medical supplies, such as therapeutic shoes and strips for blood sugar tests. Some people are normally enrolled in Medicare part B automatically.

For Medicare part B, you’re required to pay:

  • A monthly fee referred to as a premium. If you’re eligible for part B and fail to sign up, you’ll pay a penalty if you have Medicare.
  • A deductible- an amount paid annually before Part B starts paying for your medical expenses.

If a doctor doesn’t accept amounts that are Medicare-approved, you’ll be forced to pay the entire medical bill.

Part C- Medicare Advantage

Medicare Advantage is a health insurance plan usually issued by private insurance firms. The plan has all the benefits you can get from traditional Medicare and much more. To get Medicare Part C, you must enroll in Part A and Part B.

There are Part C Medicare plans that cover prescription medicine. You can also get coverage for hearing, dental, wellness programs, and vision.

If you have Medicare Part C, you must follow all the rules. For example, you should use the doctors in the plan’s network.

Part D

You can purchase a health insurance plan for a private firm even when you have Medicare. Here, the main focus is getting a plan that pays for the prescription drugs. The coverage is known as Medicare Part D. Every insurance company offering the Part D plan usually determines the drugs they’ll cover and how much they’ll cost. You must carefully review the details before choosing a Medicare Part D plan.

For Part D Medicare, you’re supposed to pay monthly premiums. If your main interest is in getting a healthcare plan that can get prescription drugs, you can opt for:

  • A Medicare Cost Plan that has prescription medicine benefits
  • Medicare Part C with prescription benefits

The premium you’ll pay for any of the plans listed above will include coverage for prescription drugs.

If you’re eligible for Part D, you can go ahead and decide whether you’ll purchase the healthcare plan or not. If you wait and are already eligible, you’ll incur a penalty. During open enrollment annually, you can always change your Medicare Part D.

Is Medicare Insurance?

Medicare caters to healthcare costs for individuals that are eligible in a similar manner to health insurance. There are no premiums for the basic Medicare parts. However, the coverage is limited compared to healthcare policies offered by private insurance firms.

Final Thoughts

The U.S. government is responsible for the Medicare health insurance program. Through Medicare, the government has managed to subsidize the cost of healthcare services. The plan is meant for seniors who are 65 or older.

Before you choose any insurance plan, ensure you’ve gone through everything that’s covered to determine whether it fulfills your needs.


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