Medicare

Medicare is the nation’s largest health insurance initiative. It was originally signed into law on July 30, 1965, by President Lyndon B. Johnson, as an amendment to Social Security legislation. Individuals are eligible for Medicare if:

• they are a U.S. citizen or have been a permanent legal resident for 5 continuous years and they are 65 years or older
• they are under 65, disabled and have been receiving Social Security or Railroad Retirement Board disability benefits for at least 24 months
• they have permanent kidney failure or need a kidney transplant
• they are eligible for Social Security Disability Insurance and have Lou Gehrig's disease

Many beneficiaries qualify for both Medicare and Medicaid. In some states, for those making below a certain income Medicaid will pay Part B premium and for any drugs that are not covered by Part D. By 2031, enrollment in Medicare is expected to reach 77 million.

The original Medicare program has two parts: Part A (Hospital Insurance) and Part B (Medical Insurance). Medicare Part D provides comprehensive prescription drug coverage. Part C Medicare Advantage plans are another way for beneficiaries to receive their Part A, B and D benefits through private health insurance plans, instead of through the original Medicare plan (Parts A and B).

The Different Parts of Medicare

Helps cover inpatient care in hospitals Helps cover skilled nursing facility, hospice, and home health care

Helps cover doctors' services, hospital outpatient care, and home health care Helps cover some preventive services to help maintain your health and to keep certain illnesses from getting worse

A prescription drug option run by Medicare-approved private insurance companies Helps cover the cost of prescription drugs May help lower your prescription drug costs and help protect against higher costs in the future

Medicare Advantage (Part C)

A Medicare Advantage Plan (like an HMO or PPO) is another Medicare health plan choice you may have as part of Medicare. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare.

If you join a Medicare Advantage Plan, the plan will provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D).

Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan for non emergency or non-urgent care). These rules can change each year.

Medicare Supplement Insurance

Medicare Supplement Insurance is an actual insurance policy that helps to cover some or all of the deductible, coinsurance, copay, and excess charges gaps in Medicare. Because this insurance covers gaps in Medicare it is often referred to as Medigap. Medicare supplements are somewhat unique in that, although this is insurance, Medicare has mandated a level of standardization that makes it easier to shop for Medicare supplements.

Some Medicare supplement plans also have features that will cover costs of certain services that are not part of original Medicare - like At-home recovery, which provides limited benefits for custodial care at your home if recovering from a surgery or medical procedure, and/or Preventive Services not otherwise covered by Medicare.

One thing that you should definitely note is that while the Medicare Supplement Plans are standardized by the federal government, Medicare Supplement rates are not. Since Medicare Supplement policies are provided by different private insurance companies their rates will vary depending upon that specific providing company’s policies.