Medicare is a federal health insurance program in the United States for individuals aged 65 and older. Additionally, it covers certain individuals under 65 with specific disabilities, such as permanent kidney failure, amyotrophic lateral sclerosis (ALS), or other qualifying conditions.
The Centers for Medicare & Medicaid Services (CMS), a federal agency, is responsible for administering Medicare. However, the Social Security Administration processes applications for Original Medicare (Part A and Part B). Funding for Medicare comes from various sources, including payroll taxes, Congressional authorizations, and beneficiary premiums. These funds are held in trust funds by the U.S. Treasury.
Medicare is divided into different parts, each covering specific healthcare services:
Medicare Part A primarily covers inpatient hospital care, skilled nursing facility care, and some home health and hospice care. Most people aged 65 and older are eligible for Part A without paying a monthly premium if they or their spouse have worked and paid Medicare taxes for a sufficient period.
Medicare Part B covers medically necessary doctors’ services, outpatient care, home health services, durable medical equipment, and mental health services. It also covers many preventive services. Part B requires a monthly premium, which varies based on income.
Medicare Advantage plans, offered by private insurance companies approved by Medicare, combine Part A, Part B, and often Part D (prescription drug coverage) into a single plan. These plans may have different costs, coverage, and provider networks compared to Original Medicare.
Medicare Part D, also provided by private insurance companies, helps cover the costs of prescription drugs. Like Part C, Part D plans have varying costs and formularies (lists of covered drugs).
For those enrolled in Original Medicare (Parts A and B), Medigap policies, offered by private insurance companies, can help cover some of the out-of-pocket costs, such as copayments, coinsurance, and deductibles.
While Medicare helps cover a significant portion of healthcare costs, it’s important to note that it doesn’t cover all medical expenses. Beneficiaries typically pay for services and treatments through monthly premiums, deductibles, copayments, and coinsurance. However, several programs are available to help individuals with limited income and resources afford Medicare costs, such as Medicare Savings Programs (MSPs) and Extra Help for prescription drug costs.
Navigating the complexities of Medicare can be challenging. For the most up-to-date information on Medicare, eligibility, enrollment, and coverage, it’s advisable to visit the official Medicare website (www.medicare.gov) or contact Medicare directly at 1-800-MEDICARE (1-800-633-4227).
