Established in 1965 under the Social Security Act by President Lyndon B. Johnson, Medicare is a federal health insurance program in the United States that primarily serves seniors aged 65 and older and specific younger individuals with disabilities or specific medical conditions. Medicare comprises several parts, each offering a comprehensive approach to healthcare, encompassing various medical services and treatments.
Medicare Part A
This part of Medicare is designed to help individuals access essential healthcare services when they require hospitalization or specialized care.
Inpatient Hospital Care
Medicare Part A covers expenses related to inpatient hospital stays. This includes services such as:
- Cost of a semi-private room, a shared hospital room with another patient
- Skilled nursing care provided during a hospital stay
- Meals and medications
- Lab tests, X-rays, and other diagnostic services that are part of the inpatient treatment
Hospice Care
Medicare Part A also provides coverage for hospice care for individuals with terminal illnesses with a life expectancy of six months or less. This includes medical services, pain management, emotional support, and other services to improve the quality of life during the final stages.
Home Health Care
Part A also includes limited coverage for medically necessary home health care services when certain conditions are met. This includes intermittent skilled nursing care and occupational therapy.
Medicare Part B
Also known as Medical Insurance, this part covers various outpatient medical services and preventive care. This is crucial in ensuring individuals access necessary medical services outside of a hospital setting.
Doctor Visits and Consultations
Part B covers visits to doctors, specialists, and other healthcare professionals. This includes consultations, examinations, and medical evaluations.
Outpatient Care
This can include services like:
- Surgical procedures performed on an outpatient basis
- Wide range of diagnostic tests, including MRIs
- Certain types of durable medical equipment, such as wheelchairs, walkers, and oxygen equipment
- Emergency and non-emergency ambulance services
Furthermore, Part B may cover occupational, individual, group, and speech therapy services.
Medicare Part C
Also known as Medicare Advantage, Medicare Part C is another way to receive Medicare benefits through private insurance companies approved by Medicare, you can learn more about medicare advantage plans here. Beneficiaries enrolled in a Medicare Advantage plan have access to:
Prescription Drug Coverage
Many plans include prescription drug coverage, combining Part A, Part B, and Part D benefits into a single plan. This can be beneficial for individuals who need regular medications.
Dental Care
Some Medicare Advantage plans cover routine dental services like cleanings, fillings, and extractions.
Vision and Hearing Care
Certain plans may cover vision-related services such as eye exams, glasses, and contact lenses. Furthermore, they may provide coverage for hearing exams, hearing aids, and related services.
Fitness and Wellness Programs
Some plans offer gym memberships and fitness programs to promote health and wellness. Additionally, the plans might offer various wellness incentives, health education, and disease management programs.
Transportation Services
Specific plans may provide transportation assistance to medical appointments or other healthcare-related destinations.
Telehealth Services
Many Medicare Advantage plans have embraced telehealth services, allowing beneficiaries to consult with healthcare professionals remotely.
Medicare Part D
It is a prescription drug coverage program that helps Medicare beneficiaries afford the cost of prescription medications. Additionally, Medicare Part D can be added to original Medicare (Part A and Part B) or to a Medicare Advantage plan (Part C) that doesn’t already include prescription drug coverage.
Prescription Drug Coverage
It covers a wide range of prescription medications, including both brand-name and generic drugs. The specific drugs covered under each Part D plan are listed in the plan’s formulary, which lists covered medications.
Additionally, each Part D plan has a premium, the monthly cost to enroll in the plan. These plans may also have a deductible, an annual amount that beneficiaries must pay out of pocket before the plan’s coverage begins.
Coverage Stages
Medicare Part D plans have different coverage stages that beneficiaries progress through as they use prescription medications:
Deductible Stage
In this stage, beneficiaries pay the total cost of their prescriptions until the deductible is met. Not all Part D plans have a deductible.
Initial Coverage Stage
After meeting the deductible, beneficiaries enter the initial coverage stage. During this stage, they pay a copayment or coinsurance for each prescription, and the plan covers the remaining cost up to a specific limit.
Coverage Gap
During this stage, beneficiaries pay more for brand-name and generic drugs until they get to the out-of-pocket threshold. Once beneficiaries reach the out-of-pocket threshold, they pay a reduced copayment for covered drugs for the remainder of the year.
Medicare offers a comprehensive range of healthcare services, comprising different parts, including A, B, C, and D. While Part A covers hospital and inpatient care, Part B covers outpatient services and preventive care. Moreover, Medicare Part C plans offer an alternative with added benefits, and Part D addresses prescription drug coverage.
