What is Medicare?

Senior Insurance Services, a nationwide insurance broker

Lets begin with a basic understanding of Medicare to guide you in making informed choices about which of the many options is right for you.

Medicare is a national, single-payer insurance program administered by the U.S. Federal Government for Americans 65 and older, some people with disabilities under age 65 and people with end-stage renal disease, who have worked and paid into the system through the payroll tax system. On average, Medicare provides coverage for about half of the health care charges incurred. Medicare is broken down into multiple parts.

Medicare Part A
Medicare Part A essentially covers hospital expenses:
* Inpatient care
* Skilled nursing facility stays
* Hospice and home health care
* Semi-private room

During your working years, you pay taxes to fund the premiums for these hospital benefits. For most Americans, the cost of Medicare Part A is nothing. If you have not paid enough over the years for premium-free coverage you may face a sizeable monthly premium.

Medicare Part B
Medicare Part B covers your outpatient expenses including:

  • Doctor visits
  • Lab work
  • Preventive services
  • Surgeries
  • Cancer therapy
  • Kidney dialysis
  • Emergency room

There is a personal cost to Medicare Part B that is determined by your income bracket and your adjusted gross income filed with recent tax returns. To offset the cost of Medicare Part B out of pocket expenses, many senior citizens purchase Medicare supplemental insurance.

Medicare Part C

Medicare Part C is called Medicare Advantage and is actually private insurance. Medicare Advantage plans are voluntary but you must first be enrolled in both Parts A and B. Before considering a Medicare Advantage Plan, there is much you need to know. Medicare Advantage plans take the place of Medicare so that you can no longer use Medicare. You must go to a network of doctors and hospitals that accept Medicare Advantage plans. You are required to pay co-payments every time you receive some form of medical care. These co-payments can total up to $6,700 per year on some Medicare Advantage plans. For example, although you may be attracted to these plans due to the low or no monthly premiums, you may spend more out of pocket in the long run for higher copayments, coinsurance or deductibles. We do offer Medicare Advantage plans and can help you decide if a Medicare Advantage plan is right for you.

We have included information about Medicare Advantage that you can read here, or continue on for a basic understanding of the various parts of Medicare.

Medicare Part D
Medicare Part D is essentially insurance to help cover the cost of prescription drugs. This federal program is administered through private insurance companies. Prior to 2006 when Part D was introduced, Medicare beneficiaries had to cover all their prescription drug costs. With Part D, Medicare recipients pay a monthly premium and a copay to manage the cost of medications. For more detail on Medicare Part D and to understand all the factors you need to know to ensure your prescription drugs are adequately covered, visit this page devoted to prescription drug plans.
Medicare vs. Medicaid
Occasionally people are confused by these similar sounding names: Medicare and Medicaid. As stated above, Medicare is a federal healthcare program for seniors 65 and above. Medicaid is a federal healthcare program for low-income individuals.
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