Jane Dotson
Medicare is a federal health insurance program in the United States for people aged 65 or older and younger people with disabilities, including those with permanent kidney failure, end-stage renal disease, or amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease). Medicare is divided into four parts: Part A, Part B, Part C, and Part D. Part A covers hospital, skilled nursing, and hospice services, while Part B covers outpatient services. Part C, also known as Medicare Advantage, is an alternative that allows patients to choose private plans with different benefit structures, and Part D covers self-administered prescription drugs. Medicare Advantage plans may offer additional benefits beyond Original Medicare, such as vision, hearing, and dental services.
| Characteristics | Values |
|---|---|
| Type of Insurance | Health Insurance |
| Administered by | Centers for Medicare and Medicaid Services (CMS) |
| Coverage | Hospital, skilled nursing, hospice services, outpatient services, prescription drugs, dental, vision, hearing, etc. |
| Eligibility | People aged 65 and older, people under 65 with certain disabilities, people with end-stage renal disease, people with ALS, etc. |
| Parts | Part A, Part B, Part C (Medicare Advantage), Part D, and Medigap |
| Cost Coverage | About half of the healthcare expenses of those enrolled |
| Cost Structure | Monthly premiums, co-pays, deductibles, etc. |
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What You'll Learn
- Medicare is a federal health insurance program for people aged 65+ and younger people with disabilities
- Part A covers hospital, skilled nursing, and hospice services
- Part B covers outpatient services
- Part C is an alternative that allows patients to choose private plans
- Part D covers self-administered prescription drugs
Medicare is a federal health insurance program for people aged 65+ and younger people with disabilities
Medicare is a federal health insurance program in the United States for people aged 65 and above, and younger people with certain disabilities. It was established in 1965 under the Social Security Administration and is now administered by the Centers for Medicare and Medicaid Services (CMS), a component of the US Department of Health and Human Services (HHS).
Medicare is divided into four parts: Part A, Part B, Part C, and Part D. Part A covers hospital, skilled nursing, and hospice services, while Part B covers outpatient services. Part C, also known as Medicare Advantage, is an alternative option that allows enrollees to choose private plans with different benefit structures, typically including the services of Parts A and B, and often with additional benefits such as vision, hearing, and dental services. Part D covers self-administered prescription drugs.
The Social Security Administration determines Medicare eligibility. Individuals with long-term disabilities that prevent them from working, such as end-stage renal disease or amyotrophic lateral sclerosis (ALS), may be eligible for Medicare before the age of 65. People receiving Social Security Disability Insurance (SSDI) benefits for 24 months are automatically enrolled in Medicare Parts A and B in the 25th month. Similarly, individuals with permanent kidney failure requiring dialysis or a transplant may qualify for Medicare, regardless of age.
Medicare enrollees can also purchase additional insurance from private companies to supplement their coverage. These supplemental plans, known as Medigap policies, help lower out-of-pocket costs for services covered by Medicare. Enrollees can also opt for Medicare Advantage plans, which bundle Parts A, B, and often Part D into a single plan with a private insurance company. These plans may offer additional benefits beyond what Original Medicare covers.
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Part A covers hospital, skilled nursing, and hospice services
Medicare is a federal health insurance program in the United States for people aged 65 or older and younger people with disabilities. It is divided into four parts: Part A, Part B, Part C, and Part D.
Part A of Medicare covers hospital, skilled nursing, and hospice services. It includes inpatient hospital stays, such as those in a skilled nursing facility or psychiatric hospital. It also covers some home health services and hospice care. However, it is important to note that Part A does not include doctor's fees during a hospital stay, which are covered under Part B.
Individuals who have worked for 40 quarters and paid Medicare tax are eligible for free Medicare Part A plans. Those who do not meet these qualifications must pay a monthly premium to remain enrolled in Part A. Additionally, there is a deductible that individuals must meet before Medicare will pay for any treatment under Part A. In 2025, this deductible is set at $1,676.
Medicare Part A also has specific rules for individuals under the age of 65 with end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS). For example, individuals with ALS can receive Part A coverage the first month after qualifying for Social Security Disability Insurance (SSDI) benefits, while the waiting period for those with ESRD varies based on their dialysis status and duration.
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Part B covers outpatient services
Medicare is a federal health insurance program in the United States for people aged 65 or older and younger people with disabilities. It is divided into four parts: A, B, C, and D.
Part B of Medicare is also known as Medical Insurance. It covers medically necessary services and preventive services. Medically necessary services are services or supplies that meet accepted standards of medical practice to diagnose or treat a medical condition. Preventive services are healthcare to prevent illness (like the flu) or detect it at an early stage when treatment is likely to be most effective.
Part B covers a wide range of medically necessary outpatient services. It covers 80% of Medicare-approved services, leaving the insured person responsible for the remaining 20%. Part B covers preventive care, including flu shots, colonoscopies, mammograms, and more. It also covers ordinary outpatient services like doctor's visits, lab testing, home health care, ambulance rides, and some chiropractic care.
Part B also covers services that sometimes occur in the hospital. This includes physician's services, radiation or chemotherapy for cancer, surgeries, diagnostic imaging, medical equipment, and even dialysis for failing kidneys. Part B will also pay for drugs administered in a clinical setting, such as osteoporosis injections, infused drugs, antigens, and insulin used with an insulin pump.
Part B is optional, but if Medicare is your primary coverage, it is strongly recommended. You also cannot get Medigap supplemental coverage without it.
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Part C is an alternative that allows patients to choose private plans
Medicare is a federal health insurance program in the United States for people aged 65 or older and younger people with disabilities. It is divided into four parts: Part A, Part B, Part C, and Part D.
Part C, also known as Medicare Advantage, is an alternative to Original Medicare (Parts A and B) that allows patients to choose private plans with different benefit structures. These plans are offered by private companies approved by Medicare and provide the same services as Parts A and B, often with additional benefits.
When you enroll in a Medicare Advantage Plan, it becomes your primary insurer, covering all your Part A (Hospital Insurance) and Part B (Medical Insurance) needs. Many Medicare Advantage Plans also offer extra coverage for services like vision, hearing, dental, and health and wellness programs. Most include Medicare prescription drug coverage (Part D).
Medicare pays a fixed amount every month to the companies offering Medicare Advantage Plans. These companies must follow the rules set by Medicare, and the rates paid for Part A and Part B services under Part C are agreed upon between the sponsor and the provider.
Part C offers flexibility and the ability to customize one's health insurance plan by choosing from a variety of private options. This allows individuals to select a plan that best suits their specific needs and preferences, ensuring they receive the care they require.
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Part D covers self-administered prescription drugs
Medicare is a federal health insurance program in the United States for people aged 65 or older, as well as younger people with disabilities, including those with end-stage renal disease and amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease). It is divided into four parts: Part A, Part B, Part C, and Part D. While Parts A and B are administered by Medicare itself, Part D is different in that it is provided through private plans.
Part D of Medicare covers self-administered prescription drugs. Before 2006, Medicare only paid for some drugs administered during a hospital stay (under Medicare Part A) or at a doctor's office (under Medicare Part B). It did not cover outpatient prescription drugs until January 1, 2006, when the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 was implemented. This Act is generally referred to as the "MMA".
The Part D drug benefit, also known as "Medicare Rx", is a voluntary program that helps Medicare beneficiaries pay for outpatient prescription drugs purchased at retail, mail order, home infusion, and long-term care pharmacies. It is important to note that Part D is not administered directly by Medicare. Instead, Medicare contracts with private companies that are approved to sell Part D insurance coverage. These companies are known as Prescription Drug Plans (PDPs) and they specialize in selling prescription drug coverage.
The amount paid for drugs under Part D is determined by the sponsor (usually a pharmacy benefit manager) and pharmaceutical distributors and/or manufacturers. The Social Security Administration is responsible for determining eligibility and collecting premium payments for Medicare Part D.
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Frequently asked questions
Medicare is a federal health insurance program in the United States for people aged 65 or older and younger people with disabilities.
Medicare is divided into four parts: Part A, Part B, Part C, and Part D.
Part A covers hospital, skilled nursing, and hospice services. Part B covers outpatient services. Part C is an alternative that allows patients to choose private plans with different benefit structures that provide the same services as Parts A and B, usually with additional benefits. Part D covers self-administered prescription drugs.
You can sign up for Medicare by enrolling in Part A and Part B. If you have other insurance, you can keep it and Medicare will pay secondary to it.
Medicare Advantage (Part C) is a Medicare-approved plan from a private company that offers an alternative to Original Medicare (Parts A and B) with additional benefits such as vision, hearing, and dental services.
