Medicare Basics

Medicare is a social insurance program administered by the United States government which provides health insurance coverage to individuals who are aged 65 and over, or who meet other special criteria.

In general, all persons 65 years of age or older who have been legal residents of the United States for at least 5 years are eligible for Medicare.

Other individuals who may be eligible include: those under 65, disabled, receiving Social Security benefits or Railroad Retirement Board disability benefits for a designated period of time: individuals on continuing dialysis for end stage renal disease or needing a kidney transplant: or individuals eligible for Social Security Disability Insurance who have Lou Gehrig’s disease.

The Medicare program has several parts:

  • Part A: Hospital Insurance:
    Part A covers inpatient hospital stays (at least overnight), including semiprivate room, food, tests, doctor's fees, and brief stays for convalescence in skilled nursing facilities under certain criteria.

  • Part B: Medical Insurance:
    Part B medical insurance helps pay for some services and products not covered by Part A, most often on an outpatient basis such as physician services, x-rays, laboratory and diagnostic tests.

    Part B also helps with durable medical equipment such as canes, walkers, wheelchairs and oxygen for home use.

  • Part C: Medicare Advantage Plans
    Individuals have a choice to receive their benefits through private insurance plans rather than the original Parts A and B. These plans must meet or exceed services provided under original Medicare.

    These individuals usually pay a monthly premium in addition to the Medicare Part B premium to receive additional benefits and may be limited to receive services through certain providers without paying additional fees.

    Medicare Advantage Plans may also include prescription drug coverage.

  • Part D: Prescription Drug Plans
    Individuals enrolled in Part A or B are eligible for Part D prescription drug assistance.

    Individuals must enroll in a stand-alone Prescription Drug Plan (PDP) or a Medicare Advantage plan with prescription drug coverage (MA-PD). Prescription Drug plans are regulated by Medicare but are administered by private health insurance companies.

 

Please be careful and make sure you understand Medicare policies and regulations before you make health care decisions.

You can reference the official federal government document (Medicare & You) published by Medicare here.