In this article, we answer the question, "What Is Medicare?" and provide information about different Medicare plans, Medicare deductibles, and Medicare enrollment.
Healthcare is a complex topic, and Medicare is no exception. It's governed by a wide variety of rules, regulations, and exemptions that always seem to be changing. However, it's essential to understand the basics of Medicare so you can use it to protect your health and well-being.
What Is Medicare?
As explained on the official Medicare site:
"Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)."
Medicare Parts A, B, C, and D
Medicare is divided into parts to address various healthcare services.
- Medicare Part A: This is basically your hospital insurance. It covers your hospital stays, hospice, and skilled nursing. In some cases, home healthcare may be included as well.
- Medicare Part B: This is medical insurance that covers your doctor visits and outpatient care as well as certain preventive tests and screenings.
- Medicare Part C: Also known as Medicare Advantage, Part C is insurance provided by a private company that has been approved by Medicare. Your Part A and Part B services are covered this way, and you may have coverage for additional services.
- Medicare Part D: This section covers prescription drugs.
When you join Original Medicare, you get Part A and B. If you'd like Part D, it requires a separate plan. If you choose Medicare Advantage (Part C), your Part A and Part B are included, and some plans include Part D as well. Medicare Advantage must provide, at the minimum, the same coverage offered by Original Medicare. This video from Medicare can be helpful in explaining Medicare options further.
How Do You Get Medicare?
For example, if you are already signed up for Social Security benefits, you'll automatically get Medicare when you turn 65. If you are not automatically enrolled in Part A and Part B, you might choose to delay Part B to avoid paying the premium, which in 2018 is $134 per month; however, in some cases you might have to pay a penalty if you join Part B later. This is why it's important to carefully consider your unique situation and whether or not you should get Part A and Part B.
What Does Medicare Cover?
The following resources explain what different Medicare plans cover:
Remember that even if Medicare covers a service, you generally have to pay your deductible, coinsurance, and copayments.
What Is Not Covered By Medicare?
There are certain services that aren't covered by Part A and Part B. According to Medicare, these include:
- Most dental care
- Cosmetic surgery
- Long-term care
- Hearing aids and exams for fitting them
- Routine foot care
- Eye examinations related to prescribing glasses
What You Need to Know About Medicare Deductibles
Like other insurance, you may have to meet a deductible or copayment before Medicare covers the rest of the cost. Here are a few of those numbers for 2018. For a complete breakdown of your costs and responsibilities, click here.
Part A (with Original Medicare)
- Hospital Inpatient: $1,340 deductible for each benefit period.
- Mental Health Inpatient: $1,340 deductible for each benefit period.
- Skilled Nursing Facility: $0 for days 1-20 of each benefit period; $167.50 coinsurance per day for days 21-100 of each benefit period; full costs for days 101 and beyond.
Part B (with Original Medicare)
- Each year, Medicare sets the annual deductible. The Medicare annual deductible for 2018 is $183. At the beginning of every calendar year, you must first meet your Medicare annual deductible before the benefits of Medicare start to take effect. After your deductible is met, you will typically pay 20 percent of the Medicare-approved amount for most doctor services, outpatient therapy, and durable medical equipment. For more details about the Medicare Deductible for 2018, please read this article.
- Premiums and deductibles will vary depending on your specific plan. Check with your current providers to make sure they participate in any Medicare Advantage plan you may be considering. Providers have the option to choose what, if any, plans they participate in, so asking if they accept Medicare will not suffice if you are considering a Part C Plan.
- Premiums and deductibles vary by plan.
- Depending upon your income, you may be required to pay a higher monthly premium.
Every situation is different. Your age, state of residence, health, income, and whether or not you already have insurance through your employer can impact the choices you make about Medicare. To determine which plan is right for you, take a look at the Medicare Plan Finder.
Medicare is a complicated system, and the information can seem overwhelming when you're looking to discover answers to the question, "What is Medicare?." Take your time to learn more about it.
Read small sections of the Medicare website every day, especially as you are getting closer to making decisions about Medicare coverage.
Consider asking your family members to read it and discuss it with you. Sometimes, repeating the information aloud or hearing someone explain it in a different way can help you understand it.
And don’t forget to explore your options, such as Medicare Supplement Insurance (Medigap). By understanding Medicare supplement plans and how they can cover your Medicare deductibles and other out-of-pocket costs, you may be able to save on healthcare costs. You can learn more about Medigap here.
Knowing what Medicare is, what your options are, and how it can help you is an important part of taking charge of your health and your life.
For more articles about what Medicare is, healthcare tips for chronic disease management, and how care coordination services from CareSync can help, click here.