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What is Medicare?

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

Medicare is an entitlement federal health insurance program, which provides U.S. citizens the right to access it by working and paying taxes for a certain number of years or quarters. A person who has not satisfied the minimum working requirements to have “Premium-Free” access to Medicare, can be allowed to access the program by paying a monthly premium. In 2019 the Part A premium will be $437 if you worked less than 30 quarters in the past 10 years or $240 if you worked 30-39 quarters in the past 10 years. To cover needed services Medicare is split into four different “PARTS”.

Parts of Medicare

Part A – Hospital Insurance

Commonly referred to as “Hospital Insurance”, Medicare Part A covers costs incurred when the beneficiary has been admitted to a healthcare facility. Skilled nursing facility, inpatient care in a skilled nursing facility (not custodial or long-term care), Hospice Care and Home Health care.

Under part A, beneficiaries don’t have to part with a minimum premium, and that’s why it’s sometimes called a “premium-free Part A.” The guarantee takes effect only if you’ve worked for at least ten years and paid your Medicare during the entire 40 quarters. And, concerning the cost, Part A often doesn’t cover the whole medical bill as you would need to pay a deductible fee before the cover takes effect.

Part B – Medical Insurance

It engulfs particular non-hospital medical costs such as X-Rays, Blood tests, Doctor’s visits, diabetic screening and outpatient hospital care. To be eligible, one must pay a monthly premium with the payments varying according to the beneficiary’s income. All Medicare Part B beneficiaries normally have to cover a part of their health care costs. They’ll have to pay a deductible fee before the program takes effect.

Part C – Medicare Advantage Plans

Medicare Part C is a health plan made available by private insurers who contract with Medicare and by law must offer at least the same benefits as required by Medicare Parts A and B. Some plans will offer prescription drug coverage, dental care, vision care and many other benefits not otherwise covered by Original Medicare. Service for these plans is done through:

● Health Maintenance Organizations (HMO)
● Preferred Provider Organizations (PPO)
● Private Fee-for-Service Plans (PFFS)
● Special Needs Plans (SNP)
● Medicare Medical Savings Account (MSA)

Part D – Prescription Drug Coverage

Medicare prescription drug coverage is an optional benefit. Medicare offers prescription drug coverage to everyone with Medicare. If you decide not to get Medicare drug coverage when your first eligible, you will likely pay a late enrollment penalty unless you have other credible drug coverage or you get extra help with drug costs. You can get your prescription drug benefit through Original Medicare by getting an optional Prescription Drug Plan (PDP) or through a Medicare Advantage Plan (MA-PD). In each case there can be additional costs such as deductibles, copayments or a portion of the full drug cost (coinsurance).

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