Understanding Medicare

What is Medicare?

Medicare is a federal insurance program that is primarily for people who are 65 or older. However, people with certain disabilities may qualify when they are under the age of 65. People with End-Stage Renal Disease or ALS can qualify for Medicare at any age.

There are four parts to Medicare:

Part A - Hospital insurance

Part A covers hospital care. Services covered by Part A include:

• inpatient hospital care
• skilled nursing facility
• hospice
• lab tests
• surgery
• home health care
• nursing home care (short-term)

Part A is included in Original Medicare.

Part B - Medical insurance

Part B covers doctor visits and services as well as preventive care. Services covered by Part B include:

• wheelchairs
• walkers
• surgeries
• flu shots
• mammograms
• colorectal screenings
• clinical research
• ambulance services
• durable medical equipment
• mental health services
• intensive outpatient program services
• limited outpatient prescription drugs

Part B is included in Original Medicare.

Part C - Medicare Advantage

Part C, or Medicare Advantage, is insurance run by private companies that have a contract with Medicare to provide Part A and B services. These plans usually offer extras not covered by Original Medicare including hearing, vision, and prescription drugs. Most insurance companies offer a Part C plan.

Medicare Advantage plans can vary widely in what they cover and how they are run. They can include HMOs, PPOs, fee-for-service, and medical savings accounts. You usually can use only the doctors and other providers allowed in the plan. Premiums, deductibles, and copays vary from plan to plan. Because there are so many Medicare Advantage plans, it is important to research and compare plans to find out which would be best for you and to check with your healthcare organization to make sure they are contracted in network with the plan you want to use.

Part D - Prescription Drugs

Part D covers prescription drug benefits. With original Medicare, you need to join a drug plan (run by a private company) and pay a monthly premium. With Medicare Advantage, drug coverage may be part of your plan. If not, you can choose to join and pay for a separate drug plan along with Medicare Advantage.

Not Covered by Medicare

Unless you have other coverage, services you will need to pay for yourself that Original Medicare does not cover, include:

• long-term care
• dental care
• eye exams for prescription glasses
• dentures
• cosmetic surgery
• massage therapy
• routine physical exams
• hearing aids & exams for fitting them
• concierge care