Medicare Explained: Understanding It and Its Various Parts

Medicare is a health insurance program under the control of the U.S. Government. Not only is this program specifically designed for people aged 65+ years, but is also available to younger individuals with serious health issues and medical conditions. The beauty of this program is that it is free to some individuals and does not carry any coverage costs. As expected, you are required to register during the period just before your 65th birthday.

Medicare

Medicare

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Eligibility conditions

For persons aged 65+ years

  • You have been a legal U.S. resident for a minimum of five years.
  • You are a retired government employee and have signed to this program.
  • You are on Social Security Benefits.

For persons under the age of 65 years

  • In case you are suffering from Lou Gehrig’s disease.
  • In case you are suffering from renal failure.
  • In case you are declared eligible for Social Security Benefits.

Medicare has a number of parts which include: Part A, Part B, Part C, and Part D. The various parts of Medicare are discussed below.

1. Medicare Part A

It is also known as Medicare Hospital Coverage. This is because it caters to inpatients that require maximum care. If you or your spouse paid for the Medicare taxes during your working years, you will not be required to pay for premiums the moment you turn 65 years. These Medicare taxes will act as your premiums. There are a number of services covered in Part A. Some of which include:

  • Home Health Care: The good thing with this service is that it is offered in your home if you require any special care. It covers you for a period of 100 days. The condition for qualifying for Part A is that you must have been in the hospital for three consecutive days as an inpatient. This will only happen within the first two weeks of being eligible for home health care.
  • Inpatient Hospital Care: This care is specifically for inpatients who have been admitted by a physician. In a Psychiatric Hospital, Medicare covers up to a maximum of 190 lifetime days while in General Hospital, Medicare covers up to a maximum of 90 lifetime days.
  • Hospice Care: This benefit is provided to terminally ill patients.

Other services covered in Part A are surgery, lab tests, and skilled nursing facilities.

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2. Medicare Part B

This Medicare Health service is responsible for the coverage of services that are not covered in Part A. It is specific for outpatients. This program is largely financed by individuals who register for it. This is a result of the high premiums they must pay on a monthly basis. Besides that, the program is optional. The benefits offered here include:

  • Durable Medical equipment such as wheelchairs and oxygen tanks. This equipment can be used over a longer period of time.
  • Therapy benefits: occupational, outpatient physical, and speech therapy offered by Medicare professionals or therapists.
  • Ambulance services: It covers emergency transportation of patients from hospitals and to hospitals.
  • Select prescription drugs: Examples of drugs that can be administered by a physician here include; anti-cancer drugs, dialysis drugs, anti-emetic drugs, and some immunosuppressant drugs.

Medicare Part B has deductibles and before it pays for anything, they first must be met.

3. Medicare Part C

This part of Medicare is also known as the Medicare Advantage. It is usually provided by a private insurance company. It offers additional items that were not covered in Medicare Parts A and B. This Medicare plan has two major types namely:

  • Preferred Provider Organization (PPO): With this plan, you can visit healthcare facilities, specialists, or doctors whether they are in your plan’s network or not. You do not require a referral in order to visit your doctor, physician, or specialist.
  • Health Maintenance Organization (HMO). This is the most common option available to patients who are in need of additional Medicare coverage that is not provided in both Hospital and Outpatient Medicare services. For this plan, you may need a referral in order to see your preferred doctor or your specialist.

Part C also covers services such as hearing, gym memberships, home-meal delivery for patients, prescription drugs, dental, transportation to physician’s appointments, and vision.

Read Also: Facts For Patients & Caregivers: When Is The Right Time To Call Hospice?

4. Medicare Part D

This Medicare Part is also known as the Medicare Prescription Drug benefit. It covers most outpatient prescription drugs and it is provided by private insurance companies. In addition, Part D also covers a wide range of vaccines that are not covered in Part B.

Medicare Prescription Drug benefit has several phases such as initial coverage, a coverage gap phase, deductibles, and catastrophic coverage.

Some of the drugs covered in this plan include anticancer drugs, antipsychotic medications, immunosuppressant drugs, HIV/AIDS treatments, Anticonvulsive treatments, and Antidepressants.

References

https://www.medicare.gov/coverage

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