Understanding Medicare

Understanding Medicare

Understanding Medicare can be tiring and confusing. Here’s a simple guide of frequently asked questions helping to break down the medical jargon and free you up to maximize your Medicare benefits!

What is Medicare?

Medicare is a national health insurance program for individuals who are 65 years and older. Additionally, Medicare provides health benefits to younger people with disabilities and those with end-stage kidney disease.

What does Medicare cover?

Medicare provides insurance coverage for services such as Hospitalization, Primary Care Physician Visits, Lab Tests, X-rays, Prescriptions and so much more.

Medicare is a 4-part system:

Part A [Hospitalization]

  • Covers hospital, skilled nursing facility, home health, and hospice care. There is no prescription drug coverage under Part A and enrollment is typically automatic if you’re receiving Social Security benefits.

Part B [Medical]

  • Covers Medical Services including but not limited to: Doctors’ outpatient services, preventative care, durable medical equipment, hospital outpatient services, laboratory tests, X-rays, mental healthcare, and some home health and ambulance services. There is some prescription drug coverage for drugs that are administered in-office, and you must enroll to receive this benefit.

Medicare Part A & B do not have drug coverage benefits; however, prescription drugs are available either as a benefit from a Medicare Advantage Plan (Part C) or by enrolling in Medicare Part D.

Part C [Advantage Plans]

  • Part C is not a separate insurance benefit, it is a coverage option to Medicare Part A and B. What does this mean? Part C allows private health insurance companies to provide your Medicare benefits, this is known as Medicare Advantage Plans. Prescription drug coverage is dependent on your provider, and Part C is an optional, opt-in enrollment process.

Part D [Prescription Coverage]

  • Part D is a separate coverage option that can be added to Medicare Part A and B. As the name suggests, Part D covers Prescription medications but you must enroll on time to claim this benefit (late enrollment penalties may apply).

Medicare Part D is more complex and intricate than the other parts, look out for another post breaking down Medicare Prescription Coverage.

Your full list of benefits is dependent on a combination of factors. For more specific questions relating to your situation, head over to www.medicare.gov/what-medicare-covers