What You Need to Know About Medicare Insurance


Medicare is the health insurance program offered by the federal government which is available to people who are aged 65 or older. This health insurance can be used by those with disabilities. It was introduced as an extended overage option for the elderly and those who are less wealthy. Those without jobs are also in need of health insurance since they are not privy to employer-based insurance, thus Medicare is useful for them. 




What Does Medicare Cover?

As you get older, healthcare costs can skyrocket as you are taking necessary precautions to keep yourself healthy. If you're 65 or older, it is best to learn more about Medicare and how you could benefit from having your medical costs. However, it is best to first determine what exactly Medicare insurance can cover for you. Open enrollment for Medicare falls between October 15th and December 7th each year, so it is best to look for Medicare coverage then. Most medical expenses can be covered by "Original Medicare" which normally includes Part A and B. Original Medicare is a fee for service health coverage plan that covers basic medical expenses assuming you have paid your deductible for each. In cases where Medicare Part A and Part B do not cover anything, there is additional Medicare coverage you can look into. This additional Medicare coverage covers items like prescription drugs and Medigap. 

The Parts of Medicare Coverage Explained

There are four different healthcare plans within the Medicare program. They are known as Medicare A, B, C, and D. The primary plans are Medicare A and B, and the others are typically add-on plans.

  • Plan A: This plan covers any hospital costs, including being admitted to the hospital and receiving hospital care. Hospital care can be care in a nursing home, or even home healthcare services, depending on the circumstances. This Medicare plan covers routine things such as lab tests, surgeries, doctors’ visits, and things such as wheelchairs or walkers that are deemed as medically necessary in order to treat a condition the patient has.

  • Plan B: This option is relatively similar to Plan A in that it covers the majority of health issues one would go to the doctor for such as routine visits, outpatient/inpatient services, lab tests, medical equipment, and preventative services. Preventative services can be defined as any treatment that is used to prevent an illness, such as the flu, by detecting it in an early stage and employing treatment to stop it from starting. Doctors who treat Medicare members cannot charge their patients more than 115% of the approved amount by the program.

  • Plan C: Medicare C is also known as the Medicare Advantage plan. To use this plan, one must be enrolled in either Medicare A or B first, and then are given this plan which offers benefits in dental plans, vision, hearing, and prescription drug coverage. Usually advantage plans are offered only by private companies who arrange contract agreements with the Medicare program in order to provide them with Part A or B benefits. These advantage plans primarily cover prescription drugs, and the pricing differs by plan provider, so it’s best to compare plans available in the area.

  • Plan D: This last plan combines prescription drug coverage with one of the original Medicare plans and other included costs. Plan D is offered by insurance companies as well as other private companies that have been approved by Medicare to offer their members these plans. It is possible that Plan D may interfere with the advantage plan, so it is necessary to speak with a Medicare representative before choosing the plan.


Qualifications for Medicare Insurance: Are You Eligible?

In some instances, individuals can be approved automatically for Medicare Part A and B, while others may have to sign up for it. Approval for these plans is based on whether or not the individual gets Social Security benefits. Those who already have disability benefits or are 65 or older are automatically approved for this health insurance and can choose if they want the advantage plan (Plan C) and/or the prescription drug coverage (Plan D). It is best to consult with a Medicare representative to see what specific qualifications are needed. For more information about Medicare eligibility, check out this helpful Medicare resource.