Health Insurance

Medicare

What is Medicare?

Medicare is a federal health insurance program for people aged 65 or older, as well as those with certain disabilities. Medicare is administered by the Centers for Medicare & Medicaid Services (CMS) and provides coverage for hospitalizations, doctor visits, and prescription drugs. It is divided into four parts:

Part A: Hospital insurance.

Part B: Outpatient medical services.

Part C (Medicare Advantage): An alternative offered by private health plans that covers all benefits under Parts A and B, plus additional benefits like dental, vision, transportation, and more.

Part D: Prescription drug coverage.

Some people are automatically enrolled in Medicare if they already receive Social Security benefits before turning 65. If not, they must sign up manually upon reaching that age. Depending on employment status and employer-provided health coverage, it may be advisable to delay enrollment.

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Medicare Beneficiaries

Medicare Part A

(Hospitalization)

Covers hospitalization services, skilled nursing facility stays, hospice care, and some home health services.

Medicare Part B

(Medical Services)

It covers medical consultations, preventive services, therapies, and essential medical equipment.

Medicare Part C

(Advantage)

All-in-one plans that combine hospital and medical coverage, and often include additional benefits like prescription drugs, dental, vision, hearing, and more.

Medicare Part D

(Prescription Drugs)

Helps cover the cost of prescription drugs needed to treat medical conditions.

Medicare

Medicare Advantage

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Medicare Advantage, or Part C, is an alternative to Original Medicare offered by private insurance companies. These plans cover Part A and Part B benefits and often include additional services such as dental, vision, wellness programs, and transportation.

To enroll, you must be enrolled in Medicare Part A and Part B and live in the plan's service area. Members receive care through a network of providers and must meet copayments, deductibles, and out-of-pocket limits.

Medicare Advantage plans may have different costs and rules than Original Medicare, so it's important to compare options and choose the plan that best suits your personal needs.

Part A (Hospitalization):

Most beneficiaries can access Medicare Part A without a monthly premium, as long as they meet one of these requirements:

For people 65 years of age or older: The beneficiary or their spouse must have worked and contributed to Medicare for at least 10 years (40 quarters).
For people under 65 years of age: Be eligible due to disability, End-Stage Renal Disease (ESRD), or Amyotrophic Lateral Sclerosis (ALS).

Payment options if you don't qualify for Part A at no cost:

- Pay a montly premium if you are enrolled in Part A but don't meet the contribution requirements.

- Have someone pay on your behalf (example: a family member or assistance program).

This benefit guarantees basic hospital coverage, either at no cost (for those who qualify) or through a premium payment.