Medicare

Medicare is a federal government run health insurance program for US citizens or those who are lawfully present in the United States and who are:

At least 65 years of age or older.
Younger than 65 and have been disabled for 2 at least years.
Diagnosed with End-Stage Renal Disease.

The program is administered by the Centers for Medicare and Medicaid Services (CMS) which responsible for determining all costs, premiums and even IRMAA surcharges as well as the corresponding thresholds of IRMAA.

The Social Security Administration (SSA) works along with CMS in contacting beneficiaries, managing funding, and collecting certain premiums. The SSA is the banking side of coverage.

Coverage is broken into many parts with each part providing its own unique coverage which is why it is commonly known as the “alphabet of health coverage”.

The Parts consists of:

Original Medicare:

Part A – Hospital Coverage.
Part B – Medical Coverage.

Beneficiaries can also add:

Part D – prescription drug coverage.
Supplemental coverage or Medigap coverage – covers the “gaps” in Part A and B.

Part C or Medicare Advantage Plans is the alternative

Private health insurers administer coverage,.
Is the competitor to Medicare.
CMS regulates all private health insurers.
Known as the network plan.

Anyone eligible can choose either Original Medicare and then option to add Part D and/or Medigap Plan OR they can choose Part C (Medicare Advantage Plan).

What do the Parts of Medicare cover?

Part A
- Inpatient hospital care.
- Inpatient skilled nursing facility (SNF) care.
- Blood (inpatient).
- Certain inpatient non-religious, non-medical health care in religious nonmedical institutions (RNHCIs).
- Home health services.
- Hospice care.
Part B
- Doctors’ services.
- Outpatient medical and surgical services, supplies.
- Clinical lab tests.
- Durable medical equipment.
- Diabetic testing supplies.
- Preventive services.
Part D
- Prescription drugs.
Supplemental or Medigap Plans
- They can cover the majority of costs that come with Parts A and B.
- The Part B Deductible cannot be covered in most states.
- May extend certain types of coverage like hospital room stays and pints of blood.

Note:

Beneficiaries that opt to have their health coverage through Original Medicare with a stand-alone Part D Plan and a Medigap Plan G policy if they are admitted as inpatient into a Medicare recognized healthcare facility for a medical condition all costs for that stay, except for the Part B Deductible, are covered.

Part C or Medicare Advantage Plans
- Must cover the same services as Parts A and B.
- Can cover prescription drugs.
- May provide services that Original Medicare does not provide like dental, vision, hearing, and transportation.

Medicare