Jane Dotson
Medicare is a federal health insurance program for individuals aged 65 and over, as well as certain individuals under 65 with specific disabilities or conditions. It is distinct from private insurance in that it does not provide plans for couples or families. Medicare consists of two parts: Part A (Hospital Insurance) and Part B (Medical Insurance). Individuals with Medicare and other health insurance, such as from their job or a group health plan, have a primary payer and a secondary payer for their coverage. Medicare offers Original Medicare and Medicare Advantage (Part C) as the two main options for health coverage. Original Medicare allows individuals to add drug coverage (Part D) and supplemental coverage, such as Medicare Supplement Insurance (Medigap), to help pay for out-of-pocket expenses.
| Characteristics | Values |
|---|---|
| Type | Federal health insurance |
| Eligibility | Anyone 65 and older; some under 65 with certain disabilities or conditions |
| Coverage | Hospital Insurance (Part A) and Medical Insurance (Part B); Medicare Advantage bundles Part A, Part B, and usually Part D (drug coverage) into one plan |
| Cost | Medicare pays part of the cost, and the user pays their share; Medicare Advantage plans may have different out-of-pocket costs than Original Medicare |
| Choice of providers | Original Medicare allows users to see any doctor or hospital that takes Medicare, anywhere in the US; Medicare Advantage plans may require users to use doctors within the plan's network |
| Supplemental coverage | Supplemental coverage is available to help pay the user's share of costs, such as Medicare Supplement Insurance (Medigap) or coverage from a former employer or union |
| Coordination with other insurance | If a user has Medicare and other health insurance, one will be the "primary payer" and the other the "secondary payer"; the secondary payer may not cover the remaining balance after the primary payer pays up to its limit |
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What You'll Learn
Medicare is federal insurance for those 65+ and some under 65 with disabilities
Medicare is a federal insurance program for US citizens aged 65 and over. It is also available to some under 65 with certain disabilities or conditions, including End-Stage Renal Disease (ESRD) and ALS (Lou Gehrig's Disease).
Medicare is split into different parts, with Part A covering hospital insurance, home or skilled nursing, and hospice care. Part B covers medical insurance. These two parts are often referred to as 'Original Medicare'. There is no need to sign up for these parts more than once, and there is usually no premium to pay for Part A. However, there is a monthly premium for Part B, even if no Part B-covered services are used.
Part C, or Medicare Advantage, is a private insurance option that covers hospital and medical costs. Part D covers prescription medications and is available as an add-on to Original Medicare. Medicare Advantage plans may also include Part D coverage. These plans are run by private insurance companies but must follow rules set by Medicare.
Medicare is different from private insurance in that it does not offer plans for couples or families. Individuals can choose their Medicare plan and coverage, regardless of their spouse's choices. Medicare can also be used in conjunction with other insurance, such as from an employer or retiree coverage. In this case, one insurance will be the 'primary payer' and the other the 'secondary payer'. The primary payer pays up to its coverage limit, and the remainder is sent to the secondary payer. If the secondary payer does not cover the remaining balance, the individual may be responsible for the remaining costs.
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Original Medicare includes Part A and Part B
Medicare is federal health insurance for anyone aged 65 or older, as well as some people under 65 with certain disabilities or conditions. Original Medicare includes Part A (Hospital Insurance) and Part B (Medical Insurance).
Part A covers inpatient hospital care, while Part B covers doctors' services and tests. Most people get Part A for free, but some have to pay a premium for this coverage. To be eligible for premium-free Part A, an individual must be entitled to receive Medicare based on their own earnings or those of a spouse, parent, or child. If you are receiving monthly Social Security or RRB benefits, at least four months before turning 65, you will get Part A automatically at age 65 without having to file a separate application.
Part B is Medical Insurance, and you must sign up for it. If you have other insurance, like from your job, it can be the "primary payer," with Medicare as the "secondary payer." This means that the other insurance pays first, and Medicare pays the remainder. If you have Medicare and other health insurance, you can choose which services to get through each type of coverage.
You can also join a separate Medicare drug plan (Part D) to get drug coverage. Additionally, you can buy Medicare Supplement Insurance (Medigap) to help lower your share of costs for services. Medicare Advantage (Part C) is a bundled plan offered by private companies that includes Parts A, B, and usually D. These plans may offer extra benefits that Original Medicare doesn't, like vision, hearing, and dental services. However, they often have different out-of-pocket costs than Original Medicare.
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Medicare Advantage is an alternative to Original Medicare
Medicare is federal health insurance for anyone aged 65 or older and some people under 65 with certain disabilities or conditions. There are two main ways to get Medicare benefits: Original Medicare (Parts A & B) and Medicare Advantage (Part C).
Original Medicare covers inpatient hospital and skilled nursing services (Part A) and doctor visits, outpatient services, and some preventative care (Part B). It does not provide any financial protection, meaning there is no limit on out-of-pocket expenses. With Original Medicare, you can go to any hospital and see any doctor or provider within the US who accepts Medicare.
Medicare Advantage is a Medicare-approved plan offered by private companies as an alternative to Original Medicare. It covers everything that Original Medicare covers (Parts A and B) and more. Most Medicare Advantage plans also include prescription drugs (Part D) and additional benefits such as dental, vision, hearing, fitness programs, and rides to doctor appointments. One of the key advantages of Medicare Advantage is that it provides financial protection with an annual out-of-pocket limit, helping to keep costs under control. However, with most Medicare Advantage plans, you need to see providers within the plan's network to avoid added costs.
When deciding between Original Medicare and Medicare Advantage, it is important to consider the differences in coverage, cost, and care provider rules to determine which option best meets your needs. For example, if you want additional benefits such as dental or vision coverage, Medicare Advantage may be a more suitable option. On the other hand, if you value the freedom to choose any healthcare provider within the US, Original Medicare may be preferred.
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Medicare Part D is optional drug coverage
Medicare is federal health insurance for anyone aged 65 and over, as well as some people under 65 with certain disabilities. The two main ways to get Medicare coverage are Original Medicare and Medicare Advantage. Original Medicare includes Part A (Hospital Insurance) and Part B (Medical Insurance). Medicare Advantage bundles Part A, Part B, and usually Part D (drug coverage) into one plan.
Medicare Part D is available to anyone who has enrolled in Medicare Part A and/or Part B. It helps cover the cost of prescription drugs, including many common medications. Part D is offered by private insurance companies that are approved by Medicare, and you can choose from a variety of plans to find one that best suits your needs. Each plan has its own formulary, or list of covered drugs, and it's important to check that the medications you need are included in the plan's formulary before enrolling.
The specific benefits and costs of Medicare Part D plans can vary, but they generally involve paying a monthly premium, a yearly deductible, and a portion of the cost of your prescriptions (called copayments or coinsurance). Some plans may also have coverage rules, such as requiring you to try a less expensive drug before covering a more expensive option. It's important to carefully review the details of each plan, including its formulary, premiums, deductibles, and coverage rules, to make an informed decision about which plan is right for you.
In addition to Part D, there are also other options for getting help with prescription drug costs under Medicare. For example, Medicare Supplement Insurance (Medigap) is extra insurance that can help pay your share of costs in Original Medicare, although it generally doesn't cover prescription drugs. Some Medicare Advantage plans may also offer additional benefits, such as coverage for prescription drugs, vision, hearing, and dental services, which are not typically covered by Original Medicare.
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Medicare Supplement Insurance (Medigap) helps pay your share of costs
Medicare is federal health insurance for anyone aged 65 or older and some people under 65 with certain disabilities or conditions. Medicare Supplement Insurance, also known as Medigap, is extra insurance that can be purchased from a private health insurance company. It helps pay for out-of-pocket costs in Original Medicare (Parts A and B) that aren't covered by the original plan, such as the 20% coinsurance. Medigap policies help fill the "gaps" in Original Medicare coverage, ensuring that individuals don't have to bear the entire cost of certain services.
When purchasing a Medigap policy, it is important to compare the costs and benefits offered by different insurance companies as they can vary. The benefits provided by each lettered plan (like Plan G or Plan K) are standardized, so they are the same no matter which company sells it. However, the costs may differ, so shopping around can help individuals find the most suitable plan for their needs at the best price.
Medigap policies can also provide additional benefits that Original Medicare doesn't cover. For example, some Medigap plans offer coverage for emergency medical care when travelling outside the U.S. (foreign travel emergency care). It is worth noting that Medigap plans generally do not cover prescription drug costs, and individuals would need to enrol in a separate Medicare drug plan (Part D) for that coverage.
To be eligible for a Medigap policy, individuals generally need to have Medicare Part A and Part B. They will also need to pay the monthly Medicare Part B premium, as well as a premium to the Medigap insurance company. Medigap policies are guaranteed renewable as long as the individual continues to pay their premiums, ensuring continuous coverage year after year.
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Frequently asked questions
Medicare is federal health insurance for anyone aged 65 and older, as well as some people under 65 with certain disabilities or conditions.
If you have Medicare and other health insurance, each type of coverage is called a "payer". The "primary payer" pays up to the limits of its coverage, then sends the remaining balance to the "secondary payer".
Medicare includes Part A (Hospital Insurance) and Part B (Medical Insurance). You can also join a separate Medicare drug plan (Part D) and choose supplemental coverage like Medigap.
Original Medicare includes Part A and Part B. You can choose any doctor or hospital that takes Medicare anywhere in the US.
Medicare Advantage is a Medicare-approved plan from a private company that offers an alternative to Original Medicare for health and drug coverage. It bundles Part A, Part B, and usually Part D coverage into one plan.
