Start With The Basics – Medicare and its 4 Parts

What is Medicare?

Medicare is health insurance for people 65 or oder, certain people with disabilities under 65, and people of any age with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant).

Original Medicare is provided by the Federal Government and covers some of the costs of hospital stays (Part A) and doctor visits (Part B), but it does not cover everything.

For example, it does not include prescriptions drug coverage (Part D).

Although you are not required to enroll in Part D, there is a penalty of 1% of the average monthly premium  for each month you delay enrollment. This must be paid monthly as long as you are enrolled in Part D. Depending on your needs, you may want to add on more coverage.

You can also purchase a Medicare Supplement Insurance (Medigap) policy which is a health insurance policy that can help cover some of the expenses that Original Medicare does not cover.  These would include co-pays, co-insurance, or deductibles. Some Medigap policies also cover certain benefits that Original Medicare doesn’t cover (like emergency foreign travel expenses).

Medigap policies don’t cover you share of the costs under other types of health coverage, including Medicare Advantage Plans (like HMOs or PPOs), stand alone Medicare Prescription Drug plans, employer/union group health coverage, medicaid or TRICARE.  Insurance companies generally can’t sell you a Medigap policy if you have coverage through Medicaid or a Medicare Advantage Plan.

What are the PARTS and What do they Cover?

PART B

(Medical Insurance)

• Services from doctors and other health care providers
• Outpatient Care
• Home Health Care
• Durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment)
• Many preventive services (like screenings, shots, vaccines, and annual wellness visits)

PART D

(Prescription Drug Coverage)

• Cost of prescription drugs (including many recommended shots or vaccines)
• Part D plans are run by private insurance companies that follow rules set up by Medicare