Health & Benefits

Medicare is a federal health insurance program. Medicare pays a portion of hospital and other medical bills. It helps:

• people 65 or older,
• younger people with disabilities, and
• people of any age with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).

Medicare is run by the Centers for Medicare and Medicaid Services (CMS). CMS is a federal government agency.

The Social Security Administration (SSA) works with CMS. The SSA enrolls people in Medicare and collects the premiums Money that must be paid every month, such as for health insurance . CMS also hires private insurance companies to process and pay Medicare claims.

In order to receive Medicare coverage, your medical services must come from one of the following:

• Doctor,
• Hospital, or
• Other health service providers that accept Medicare.

Most doctors and medical providers participate in Medicare.

Types of Medicare

There are 4 parts to Medicare: A, B, C, and D.

Medicare A: Hospital insurance and Medicare B: Medical insurance

Under Medicare, the federal government provides coverage under Part A and Part B. You have your choice of doctors, hospitals, and other providers. You or any supplemental insurance you buy will pay the deductibles and coinsurance. You usually pay a monthly premium for Part B.

Medicare Part A covers things like:

• Inpatient hospital care,
• Skilled nursing facility care,
• Hospice care,
• Home health care,
• Lab tests, and
• Surgery.

Medicare Part B covers things like:

• Medically necessary services and supplies,
• Outpatient care,
• Home health care,
• Durable medical equipment,
• Ambulance services,
• Mental health (inpatient, outpatient, partial hospitalization),
• Limited outpatient prescription drugs,
• Clinical research, and
• Certain preventive services to maintain health and prevent certain illnesses.

Learn more about Medicare Part A and Medicare Part B.

Medicare C: Managed care

A Medicare Advantage Plan (like an HMO or PPO) is another choice you may have. Sometimes called Part C, these plans are offered by private companies approved by Medicare.

Medicare pays the same amount for your care every month to the companies offering these plans. These companies must follow rules set by Medicare.

If you join a Medicare Advantage Plan, the plan will provide all of your Part A and Part B coverage and may offer some additional services. It does not need to cover hospice care.

Learn more about Medicare Part C.

Medicare D: Prescription drug coverage

Medicare Part D plans will help pay for certain prescription drugs. Medicare Part D is run by private insurance companies approved by Medicare. These private insurance companies follow the rules set by Medicare. Eligible people can choose to join a prescription drug plan.

Most people will have to pay premiums, a deductible, and co-payments Money paid for health care in addition to what the insurer pays . Low-income persons may get extra help from the government to pay some or all of these costs. The plans will vary in coverage and cost. You can choose from different plans.

Learn more about Medicare Part D.

Medigap

You can choose to get extra insurance coverage. It fills gaps in your Medicare coverage for your special needs. This is called Medigap or Medicare Supplement Insurance. You can buy a Medigap policy from a private company. Costs vary by policy and company. Some employers or unions may offer similar coverage.

Medigap policies can no longer be sold with prescription drug coverage, but if you have drug coverage under a current Medigap policy, you can keep it. If you join a Medicare drug plan, your Medigap insurance company must remove the prescription drug coverage under your Medigap policy and adjust your premiums. Call your Medigap insurance company for more information.

Learn more about Medigap.

Note: If you join a Medicare Advantage Plan, you don't need a Medigap policy. You can't use a Medigap policy to pay for out-of-pocket costs under the Medicare Advantage Plan. If you have a Medicare Advantage Plan, you can't be sold a Medigap policy.

More Medicare information

For general information about Medicare, call (800) 633-4227 (toll-free) or (800) 820-1202 (TTY) or visit Medicare's website. You can also learn more from the official Medicare handbook, Medicare & You.

These are some good internet resources to help you learn more about Medicare:

• The American Association of Retired Persons: The AARP’s website provides a guide to Medicare. It focuses on traditional coverage, prescription drug coverage, and Medigap plans.
• Centers for Medicare and Medicaid Services: The CMS website describes CMS programs and activities. CMS is the federal agency that administers Medicare, Medicaid and the State Children’s Health Insurance Program (SCHIP). The website contains links to information on these programs.
• Medicare Rights Center (MRC): The MRC provides free counseling services. They work with older adults, people with disabilities, and Medicare recipients. MRC ensures these groups can access good, affordable health care. This site provides basic information about Medicare. It also covers questions about prescription drug coverage. It includes a glossary of Medicare terms and a chart that compares plan options.