Medicare Basics

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Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).

Originally Medicare generally covers 80% of the healthcare costs.  Most people look at Medicare Supplemental Plans to help pay the other 20% of out-of-pocket costs.

There are basically 2 main parts that make up Medicare ... Part A and Part B.  The different parts help cover specific services.  We know it can be a little confusing with all the letters A, B, C, D ... it's like Alphabet Soup!  Watch this short video to help understand the Medicare Basics.

In general, Part A covers: 

Hospital care, Skilled nursing facility care

Nursing home care, Hospice, Home health services. 

Part B covers things like:

Medically necessary outpatient & preventive services, Ambulance, Durable medical equipment, second opinions ...

Part C, also known as a Medicare Advantage Plan,  is actually a type of Medicare health plan in which you buy directly from a private insurance company who has contracted with Medicare to provide you with all your Part A and Part B benefits.  

Medicare Advantage Plans can be offered with a HMO (Health Maintenance Organizations) or a PPO (Preferred Provider Organizations) network, therefore you could have less doctors than you would if you had original Medicare.  They are also offered as Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. 

If you’re enrolled in a Medicare Advantage Plan, you may have some Medicare services that are covered through the plan that aren’t paid for under Original Medicare. In addition, most Medicare Advantage Plans offer prescription drug coverage.

Part D is the prescription drug coverage of Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans. These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.

Under Medicare Part B (Medical Insurance) the following preventive & screening services are covered:

PREVENTIVE & SCREENING SERVICES

Abdominal aortic aneurysm screening

Alcohol misuse screenings & counseling

Bone mass measurements (bone density)

Cardiovascular disease screenings

Cardiovascular disease (behavioral therapy)

Cervical & vaginal cancer screening

Colorectal cancer screenings

Depression screenings

Diabetes screenings

Diabetes self-management training 

Glaucoma tests

Hepatitis C screening test

HIV screening

Lung cancer screening

Mammograms (screening) 

Nutrition therapy services

Obesity screenings & counseling

One-time “Welcome to Medicare” preventive visit

Prostate cancer screenings

Sexually transmitted infections screening & counseling

Shots:

Flu shots

Hepatitis B shots

Pneumococcal shots

Tobacco use cessation counseling

Yearly "Wellness" visit

As much as we would like to believe it, unfortunately Medicare doesn't cover all expenses.  If it isn't a Medicare covered expense, then you will have to pay for it yourself unless you have a separate insurance or you are in a Medicare health plan that covers these types of services.  Even if Medicare does cover the service, remember ... you still may have to pay your deductible, coinsurance, and copayments unless you have a Medicare Supplemental Plan.

Some services that Medicare doesn't cover include:

Long-term care (also called custodial care)

Most dental care

Eye examinations related to prescribing glasses

Dentures

Cosmetic surgery  

Acupuncture  

Hearing aids and exams for fitting them

Routine foot care