I think that we all know that if you live long enough, you will be eligible to join at some point in your life, regardless of circumstances. But did you know that some young people qualify for Medicare? Did you also know that you can actually get private insurance through a Medicare program or that there were caps on how much healthcare providers can charge you through Medicare?
Yes, there’s a lot more than meets the eye here. Let’s dig into Medicare and the four parts of it.
Though it was originally created in 1965 to help senior citizens get better access to healthcare, some children and people with certain medical conditions are also eligible for the federally funded health insurance program:
There are four different parts of Medicare. Each type, or part, is designed to help with or cover certain specific types of medical services:
Medicare Part A is essentially a form of hospital insurance, and it is a part of what is referred to as “Original Medicare” along with Part B. Part A covers any inpatient stays at a hospital as well as hospice and nursing home (skilled but not custodial or long term care) visits and even in-home care. It’s always a best practice to communicate with your doctor or health care provider to find out if a specific form of inpatient care is covered by your Medicare plan.
As far as costs go, most people with Medicare Part A do not pay a monthly premium. Those that do might pay between $240 and $437 each month in 2020. Part A does have a $1,364 deductive but there’s also no coinsurance for the first 60 days of each benefit period. After that, charges progressively increase for coinsurance. There is also a copayment due along with your services.
Medicare Part B is essentially a form of medical insurance, and it’s the other half of what’s referred to as Original Medicare. This part covers most of your doctor’s office visits as well as trips to any outpatient facilities. Part B also covers costs related to medical supplies that help diagnose or treat your condition as well as preventive services that are designed to prevent illness or aid in early detection of a condition when treatments are most effective.
Some other important medical items that Part B covers:
If your healthcare provider accepts Medicare, you should pay nothing out-of-pocket for most preventative services. Talk to your doctor or physician’s assistant to find out if your services or supplies are covered by Medicare. If not, you might ultimately have to pay out of pocket. There is, of course, also copayment due along with your services.
Medicare Part C is often referred to as Medicare Advantage or Medicare Advantage (MA) Plans. It’s essentially an all-in-one private insurance alternative to Original Medicare. These MA Plans are actually private insurance plans that were approved through Medicare. In order to join a Medicare Advantage Plan, you must have Part A and Part B as well. Bundled together, Parts A, B, and C can cover all Medicare’s services, as well as additional coverage offerings like hearing and dental plans.
Companies that follow the rules set forth by Medicare are paid a fixed amount for your medical care each month. These plans have some out-of-pocket costs as well as different rules, which can change each year, for you to follow in terms of medical services. Each plan will have different payment plans that you should choose to best suit your needs and economic means. Check out Medicare’s plan comparison tool for more information on the private plans offered through Medicare.
Medicare Part D is essentially an optional prescription drug coverage add-on benefit for anyone who has Medicare. People who just have “Original Medicare” (Parts A and B only) do not get prescription drug coverage. (You can purchase a private plan through Part C for your prescription drug coverage too.) Anyone with one of the following Medicare plans would be eligible for Medicare Part D:
There are a variety of Medicare Prescription Drug Plans, and each varies both in cost and in the selection of prescription drugs covered in the plan. All Part D prescription drug plans are required to maintain a minimum standard set by Medicare. Most Medicare prescription drug coverages categorize medications into tiers, which each cost a different amount. (For example, drugs from a lower-tier cost less than drugs from higher tiers.)
Talk with a doctor or health care provider about which Medicare prescription drug plans or tiers are right for you. If your doctor and you decide that you should take a drug from a higher tier than you’ve initiated, you are allowed to ask for an exception, though it might not be granted.
Unfortunately, Medicare does not cover all medical services. For things that are not covered, you will have to pay out of pocket unless you’ve purchased either another private insurance plan or a Medicare Advantage plan that covers it. Medicare lists some uncovered items on their website. However, you’ll find that most of the things you need health-wise are covered under Medicare. Our healthcare system is very complicated but it helps to know what’s available to you as a U.S. citizen — even if you have to wait a few years (or decades)!