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Understanding Your Medicare Fundamentals

Understanding your Medicare fundamentals
Medicare helps you pay for the high cost of medical care. Whatever type of Medicare plan you choose, you need to understand the basics of Medicare. If you are about to turn 65 or getting Medicare for other reasons, read this before choosing a Medicare plan.

Understanding medicare and its parts
Before you look at the various options in Medicare plans, you need to understand Medicare basics.

What is Medicare?
Medicare is a health insurance program by the federal government for anyone who is 65 years or older. Medicare can also be availed at a younger age in certain circumstances.

When will you receive medicare?
You are eligible for Medicare if you are 65 or older. You can also avail of Medicare when you are younger, but:

You have Amyotrophic Lateral Sclerosis (ALS).
You have End-Stage Renal Disease requiring dialysis or need a kidney transplant.
You are already receiving disability benefits from the Railroad Retirement Board (RRB) or the Social Security Administration (SSA).

What are the parts of Medicare?

There are four parts in Medicare: Part A, Part B, Part C, and Part D.
Each focuses on different types of benefits covered, except for Part C, which is a little different.

What benefits does Part A cover?

Part A is hospital insurance, and it covers the costs of inpatient medical care.
If you are admitted in a hospital for essential medical care, Part A covers the costs for the first 60 days of your inpatient medical care.
You will have to pay a deductible.
After the initial 60 days, Medicare cover begins to decrease, and you will have to pay a higher share of the cost incurred.
In some cases, Medicare Part A can also cover the cost for your care in a skilled nursing facility or a hospice.

What does Part B cover?

Part B is your medical insurance; it covers outpatient care.
This includes visits to the doctor, costs for physician services, use of medical equipment, diagnostic tests, and costs of durable medical equipment you need, like canes, wheelchairs, prosthetic devices, etc.
Typically, Part B covers 80% of the costs for these services and equipment. The remaining 20% is to be covered by you.
You have to pay a premium for Part B benefits. There is a base premium plus an income-adjusted premium for those in higher income brackets.

What is Part C?

Part C is not a category that provides benefits. It is an alternative method of receiving the Original Medicare benefits.
These Medicare plans are called Advantage Medicare plans.
There are different types of Advantage Medicare plans.
Some of these plans may also include Part D prescription drugs coverage.

What is covered under Part D?

Part D covers the cost of drugs.
The Part D insurance plans enable you to get your essential medicines at a much lower cost than retail.
You will need to pay a premium for Part D coverage.
Like Advantage Medicare plans, Part D coverage is offered by private providers who are in contract with Medicare.
Each Part D plan will have different drug formulations.
You can use a plan finder tool on the Medicare website to help you choose the Part D plan that suits your needs.

What are your costs for Medicare?

Part A is free for all those enrolled in Medicare; there is no premium.
You will have to pay a deductible for your hospital stay.
You will have to pay a premium for Part B and also for Part D.

What are the 2018 Medicare premiums?

In 2018, the deductible you have to pay to get Part A coverage for your inpatient hospital care is $1340.
Part B premium in 2018 is $134. This is for the low-income group. If you earn a higher income, you will have to pay more.
The average premium for Part D drug plans is $34 per month.
Even if you buy private Medicare plans like Advantage Medicare plans or Medigap, you will still be enrolled in the Original Medicare, so you will still have to pay the Part B premium.

What’s the difference between Medicare Advantage plans and Medigap?

Medicare Advantage Plans may provide additional benefits besides the coverage provided by Original Medicare. Some of these plans may also come with Prescription Drugs coverage (Part D).
Medigap Plans are not alternatives to Original Medicare. Instead, they cover deductibles, and the other costs you have to pay out-of-pocket. In effect, they cover the gap between total medical care cost and what Medicare pays.

We hope this article has given you a clear idea about what Medicare is and what it covers.

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