Medicare Insurance is a Federal Health Insurance plan that pays for various health care expenses. It is administered and regulated by the Centers for Medicare & Medicaid Services (CMS). Medicare beneficiaries are usually those who are 65 or older. Individuals under 65 with certain permanent disabilities or those with End-Stage Renal Disease (ESRD) also qualify.
[/custom_frame_left]Most U.S citizens qualify for Medicare by having worked and paid taxes for a required amount of time. Typically, spouses who stayed home may also qualify even though they never personally paid into the program. Additionally, those who did not work long enough can still be eligible for benefits, but will be required to pay a higher premium. Individuals who are permanently disabled or have been disabled for at least 2 years can also qualify for benefits.There are multiple parts of Medicare and it is very important to understand how they coincide.
Medicare Insurance Plans
Medicare Part A is your Hospital Insurance. Most people do not pay for Part A because they or a spouse already paid for it through their payroll taxes while working. For those qualifying at 65, it usually takes effect on the 1st day of your birthday month. Medicare Part A helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. However, beneficiaries must meet certain conditions to get these benefits.
Medicare Part A does not cover all of your costs for services. Typically you will still be responsible for 20% co-insurance plus any co-pays or deductibles that may apply.
Medicare Part B is your Medical Insurance. Part B of Medicare covers your doctor’s visits, blood tests, x-rays and outpatient care and home health services. Most people will pay a monthly premium to participate and the rates are subject to change every year for new enrollees. The premiums can be more expensive for those who have high income or people who did not work long enough to be eligible.
As of 2011, Part B has a $162 Annual Deductible before benefits can begin. Once you meet the deductible you will normally pay 20% of the bill when you see Medicare contracted physician.
Medicare Part C is Private Insurance or better known as a Medicare Advantage plan. This is optional, however in order to qualify you must be participating in both Medicare Parts A & B.
In order for a Medicare Advantage plan to exist it must meet the minimum standard benefits offered by Original Medicare (Parts A & B). They generally offer additional benefits such as lower co-pays, dental plans, eye exams or other services. These plans are offered by Private Insurance carriers and benefits can vary based on company and regions.
Medicare Part D is Prescription Drug Insurance. This part of Medicare is also optional and is also offered through Private Insurance companies. It helps cover the costs of prescription medications according to the plan benefits. These costs can consist of deductibles, co-pays or a percentage of the full drug cost. Even if you do not take any medications it is recommended to purchase a plan when you are first eligible. If you decide to join later, you will have to pay a penalty for as long as you have a Medicare Drug Plan.