What Is Medicare – How Medicare Works

Medicare is a national health insurance program the United States government has rolled out. The program aims at offering health care for individuals 65 years and above. It also covers a younger group with disabilities. Another group that benefits from the federal government program is people with kidney failure that need to undergo a transplant or dialysis.

The significant benefit of Medicare is it pays most of the medical bills for eligible persons. However, it’s worth noting that the coverage does not cater to all expenses. Thus, you should get prepared to cater for some out-of-pocket fees. Medicare is categorized into four major parts. There are also smaller supplemental plans such as plan G, which you can read more about here at https://boomerbenefits.com/faq/is-plan-g-a-medicare-advantage-plan/ .

Medicare Part A – Hospital Insurance

Part A of Medicare covers your inpatient care. The bills covered will include your medications, nurses, meals, and room. It will also cover your hospice care if your doctor certifies you have a short time to live and other home health care to help improve your health. However, to qualify for these benefits, you need to meet some conditions.

It’s worth noting that many people qualify for Medicare part A. As a result, they don’t have to make monthly payments. It will apply if you or your partners have worked for over 10 years. During this period, you will have paid your Medicare taxes and can qualify for it. If you and your spouse are above 65 years and have not worked for the said duration, you can opt to buy part A.

Notably, the amount for the Medicare part A will be determined by how long you have worked. In addition, for your bills to get covered by part A, you will have to meet your deductibles.

Medicare Part B- Medical Insurance

Part B caters to outpatient services which include: doctor’s appointments, tests, and screening. Medicare part B may also pay for you to participate in a clinical research study and durable medical equipment such as oxygen tanks and walkers.

For Medicare part B, you will also have to pay a monthly premium. The premium amount varies; thus, you are subject to paying more if you earn a high income. You may also have to pay more if you didn’t enroll for part B when you were eligible for it. For this part, you will also have to pay an annual deductible of 20% for medical supplies and services.

Note that there are services and items that Medicare Parts A and B do not cover. They include: most dental procedures, eye exams, cosmetic surgery, hearing aids, long-term care, and physical exams. You will have to pay for these services if you don’t have other coverage.

Part C- Medicare Advantage

Part C is a health insurance plan that private insurers offer that Medicare acknowledges. You can be provided some services and products from Medicare parts A and B for this part. Some benefits you can get include; eye and ear exams and dental tests. Additional services under your Medicare advantage may include transportation for your doctor’s appointments and wellness programs.

Some plans under this category may pay for your medical prescriptions, which get covered under part D. For Medicare Advantage, the government pays the insurer a monthly amount for your medical expenses. Additionally, the insurer will determine your out-of-pocket payments.

To be eligible for Medicare part C, you need to have Part A and B. You also have to live in the service area of the Medicare part C provider. Also note that with Medicare part C, your provider can change the out-of-pocket costs at least once a year.

Medicare Part D- Prescription Drugs

Medicare part D is a program that will cover your prescription drugs. Understand that the price of these medications differs from plan to plan. Additionally, drugs in this plan are categorized into ‘tiers.’ Thus, medicines on the higher tier are costly.

If Medicare covers you, you can opt into part D. By opting in, you will be charged similar fees in standard insurance plans. It includes annual deductibles and monthly premiums.

When you become eligible for Medicare is the right time for you to enroll in part D. If you decide to opt-in later, you will need to pay a late enrollment penalty. However, you can get exempted from the liability if you have a creditable drug prescription plan.

To enroll in Medicare part D, you must have parts A and B. You don’t need to opt for part D if you have drug prescription coverage under your Medicare Advantage plan.

Medicare is an ideal program as it helps your financial burden on medical bills. However, to benefit from it, make sure to start early. Research before you are 65 to avoid confusion and know what you are signing up for. Also, you can call Social Security to help answer any questions you may have to make your decision.