What is Medicare?
Medicare is a national health care program funded by the U.S government. The program was created as part of amendments to the Social Security Act in 1965 to give coverage to people ages 65 and older who didn’t have any health insurance. It is now administered by the Centers for Medicare and Medicaid Services (CMS) and extends coverage to include people with certain disabilities and those who have end-stage renal disease and amyotrophic lateral sclerosis (ALS), or Lou Gehrig’s disease. The program is meant to help with the cost of healthcare, but it does not cover all medical expenses or the cost of most long-term care.
When you first enroll in Medicare, you can choose how you get your Medicare coverage. There are two ways to receive the benefit. The first way is Original Medicare, commonly referred to as “Straight Medicare”. The second option is your Medicare Advantage plans. These plans are known as Medicare Part C plans. Let’s break these down a bit!
You may know this benefit as straight Medicare. Different from a Part C Medicare plan, Original Medicare provides coverage directly from the Medicare program without an intermediate provider. Original Medicare includes part A which is hospital insurance, and part B which is medical insurance. You must be aware that part A, nor part B cover medication cost. You can enroll in a part D plan to help with pharmaceutical costs, and you can also shop for and buy a Medicare supplemental plan. Having a supplemental plan, for example a Medigap supplemental insurance or from a former employer can help you with coinsurance cost to Medicare and assist with cost of medications.
If you can’t afford your Medicare premiums, or coinsurances. You may be eligible to receive assistance from your state. One example of state assistance is Medical. Combined with Medicare, your medical benefit may cover most if not all your coinsurance, deductibles, or other medical expenses. To qualify for state assistance, you must have limited income and resources.
Also known as Part C plans, Medicare Advantage is an “all in one” alternative to original Medicare. Advantage plans include part A, part B, and in many cases part D benefits which cover the cost of medications minus any deductibles you may have. Some part C plans may cover additional benefits such as dental, vision, and hearing. They may also reduce your out-of-pocket costs in comparison to original Medicare.
There are four distinct parts of Medicare, all of which provide different services to the ensured.
- Medicare Part A – Part A covers inpatient hospital stays, skilled nursing facilities, hospice, and some home health care.
- Medicare Part B – Part B covers doctor services, some outpatient services, home health, medical supplies, and preventative services.
- Medicare Part C – These are your Medicare advantage plans. It is important to know that Medicare advantage plans are offered by private insurance companies that contract with Medicare to provide services. They bundle your Medicare part A and part B plans, in addition Medicare advantage plans include a Medicare part D plan, which will help with medication coverage. Other services bundled in these plans include vision, dental, and hearing. Be aware that services offered, and premiums may vary from year to year. As a beneficiary, you can change plans yearly during Medicare’s annual election period (AEP).
- Medicare Part D – Part D is the part of Medicare that covers most outpatient prescription drugs. Original Medicare recipients can purchase part D as a standalone plan from private companies. Part D is also obtainable through Medicare advantage plans.
Getting started with Medicare
Medicare is health insurance for everyone 65 or older, and you’re eligible to sign up for Medicare 3 months before your 65th birthday. You may be eligible to get Medicare earlier if you have a disability, End-Stage Renal Disease (ESRD), or ALS (also called Lou Gehrig’s disease). For more information, or to get started with Medicare visit https://www.medicare.gov/basics/get-started-with-medicare?utm_medium=Search&utm_source=Gooogle&utm_campaign=New2Medicare22_Eng&utm_content=pn-02252022_Enrollment_V1
Here are some YouTube videos that will help you navigate this information.
Concluding thoughts from New Era HH
Medicare is a great benefit we pay into in our younger days. It is important to understand what the benefits are, how to access the benefit and more importantly, how we can benefit from it the most. At New Era, we believe information, and education should be easily accessible to all. We hope you enjoyed this content. Sign up for our newsletter to receive updates on healthcare related topics, and events. We’d love your feedback!! Please leave any comments or questions below.
You can reach us at any time using the messenger app on our website at https://www.newerahh.com.
In need of nursing and rehabilitation services? You can find a full list of services at https://www.newerahh.com/services/. New Era HH is a Medicare provider, and home health services are covered under your Part A and B. Please note that all information provided is free for educational purposes only. As a Medicare recipient, you have the right to participate in your care, and you have the right to choose your own care team.
U.S. Centers for Medicare and Medicaid Services. (n.d.). History. CMS. Retrieved April 14, 2022, from https://www.cms.gov/About-CMS/Agency-Information/History
Medicare. (n.d.). Parts of Medicare. Medicare. Retrieved April 14, 2022, from https://www.medicare.gov/basics/get-started-with-medicare/medicare-basics/parts-of-medicare
What’s Medicare? Medicare. (n.d.). Retrieved April 14, 2022, from https://www.medicare.gov/what-medicare-covers/your-medicare-coverage-choices/whats-medicare
U.S. Centers for Medicare and Medicaid services. (n.d.). Original Medicare (part A and B) eligibility and enrollment. CMS. Retrieved April 14, 2022, from https://www.cms.gov/Medicare/Eligibility-and-Enrollment/OrigMedicarePartABEligEnrol
Social Security Administration. (n.d.). Medicare information. Medicare Information. Retrieved April 14, 2022, from https://www.ssa.gov/disabilityresearch/wi/medicare.htm
Center for Medicare and Medicaid Services. (n.d.). CMSHHSgov. YouTube. Retrieved April 14, 2022, from https://www.youtube.com/user/CMSHHSgov