What is Medicare?
Medicare is health insurance for people 65 or older, people under 65 with certain disabilities, and people of any age with End-Stage Renal Disease. It ensures that all seniors have basic hospital insurance (Part A) at no cost to them. It also provides the option of medical insurance (Part B). Part A & Part B make up what is called Original Medicare. Part A comes at no cost to the senior, as long as the individual has worked at least 10 years in the U.S. Part B involves a monthly premium that’s generally automatically taken out of Social Security.
There are 4 parts of Medicare. These include Part A, B, C, and D.
Part A covers hospital care, providing you with affordable inpatient care. It also covers post hospital care, such as skilled nursing facility care, hospice care, and home health care. Part A, however, does not cover long-term care.
Part B – Medical Insurance: Covers 80% of the cost of doctor’s visits, surgeries, lab tests, x-rays, ambulatory services, outpatient care, home health, hospital beds, wheelchairs, walkers, blood supplies, and medical supplies. It may also cover clinical research, mental health services, second opinions before surgery and limited outpatient prescription drugs. Coverage must be determined medically necessary or preventive.
Part C – Medicare Advantage Plans: Optional private plans that replace Part A & Part B but are required to carry the same benefits, if not more.
Part D – Prescription drug coverage: Optional drug coverage for those with Part A & Part B. For those who’ve enrolled in an Advantage Plan, they must choose a plan with built-in prescription drug coverage; they cannot apply for Part D coverage separately.
The Need for Medicare Supplements or Advantage Coverage
The above Medicare structure covers the basics for some seniors, but leaves many with high out-of-pocket costs. Private insurance companies offer Medicare Advantage Plans and supplemental plans to alleviate the financial burdens imposed by relying solely on Part A & Part B for senior health care coverage.
These private plans charge a monthly premium and can offer coverage that protects financial assets in the event medical services needed are not covered by Original Medicare coverage. We work with many seniors and their families to understand Medicare options and provide cost breakdowns and comparisons so that they can make an informed and wise choice about Medicare plans and supplements when open enrollment hits.