Introduction to Medicare

The Medicare Program

Medicare is a health insurance program for:

• People age 65 or older.
• People under age 65 with certain disabilities.
• People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant)

What is Original Medicare Plan?

The Original Medicare Plan is a "fee-for-service" plan. This means you are usually charged a fee for each health care service or supply you get. This plan, managed by the Federal Government, is available nationwide. If you are in the Original Medicare Plan, you use your red, white, and blue Medicare card when you get health care. 

Original Medicare Has Two Parts

Part A

Hospital Insurance. (see Medicare Part A)

Most people pay for Part A through their payroll taxes when they are working.

Part B

Medical Insurance. (see Medicare Part B)

Most people pay monthly for Part B.

Depending on the size of the employer, you may be able to delay Parts A and B without having to pay a penalty if you enroll later. 

Medicare Part A Helps Cover Your Hospital Stays and Inpatient Care. 

Hospital Stays

Semiprivate room, meals, general nursing, and other hospital services and supplies. This includes inpatient care you get in critical access hospitals and mental health care. This doesn't include private duty nursing, or a television or telephone in your room. It also doesn't include a private room, unless medically necessary. Inpatient mental health care in a psychiatric facility is limited to 190 days in a lifetime.

Skilled Nursing Facility Care

Semi-private room, meals, skilled nursing and rehabilitative services, and other services and supplies (after a related 3-day inpatient hospital stay).

Hospice Care

For people with a terminal illness, includes drugs for symptom control and pain relief, medical and support services from a Medicare-approved hospice, and other services not otherwise covered by Medicare. Hospice care is usually given in your home. However, Medicare covers some short-term hospital and inpatient respite care (care given to a hospice patient so that the usual caregiver can rest).

Blood

Pints of blood you get at a hospital or skilled nursing facility during a covered stay.

Medicare Part B Helps Cover Doctor Services and Outpatient Care

Medical Expenses

Helps cover your doctors' services and outpatient hospital care, such as surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment, and some home health care.  Part B helps pay for these covered services and supplies when they are medically necessary. 

Clinical Laboratory Services

Blood tests, urinalysis, some screening tests, and more.

Home Health Care

Part-time or intermittent skilled nursing care and home health aide services, physical therapy, occupational therapy, speech-language therapy, medical social services, durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers), medical supplies, and other services.

Blood

Pints of blood you get as an outpatient or as part of a Part B covered service.

MEDICARE HEALTH PLANS

 After you enroll in Original Medicare (Part A and Part B) there are two ways to get additional coverage.

These plans are offered by insurance companies and other private companies approved by Medicare.

OPTION 1

MEDICARE SUPPLEMENT & STAND-ALONE PRESCRIPTION DRUG PLAN

In addition to Original Medicare (Part A and Part B) you can enroll in a Medicare Supplement Plan (also known as Medigap) which are comprised of a variety of “lettered plans” to cover up to 20% of the costs not covered by Original Medicare.

You must have Medicare Part A and Part B to enroll in a Medicare Supplement Plan

PRESCRIPTION DRUG PLANS - Part D  (see Medicare Part D)

These plans are offered by private insurance companies approved by Medicare.

You must be enrolled in Medicare Part A and/or Part B to enroll in a Prescription Drug Plan.

OPTION 2

MEDICARE ADVANTAGE PLANS – Part C  (see Medicare Part C)

Combines Part A (Hospital) and Part B (Medical) into one plan and it usually includes Prescription Drug coverage (Part D).  These plans may offer additional benefits not provided by Original Medicare.

Depending on where you live, you may have different choices. You may make a choice when you are first eligible for Medicare, or you can enroll under a Special Enrollment Period if it applies to you, such as losing your employer coverage or moving out of your area. Each year during the Annual Enrollment Period, between October 15th and December 7th you can review your needs and switch your Medicare Advantage and Prescription Drug plans, or simply let your plan roll over into the next year.  It’s important to review your plan’s Annual Notice of Change letter that you receive in the Fall each year which describe any changes in your plan for the following year.