What Does Medicare Cover Mean?
13 Jan, 2012
Access to health care has been a growing concern in the US since several years. Many people, especially seniors are burdened with overwhelming medical bills. Medicare program was brought into effect by the US government to help out these and a few other eligible individuals. Understanding the details about Medicare gets a bit confusing for many people. It will be a tad easier for you to know about the various facts related to Medicare if you are aware of the answer to the question, what does Medicare cover mean, first.
Approximately 40 million Americans are participating in the largest health care insurance service of the US, which is Medicare. The eligibility criterion expects you to be a citizen of the US, with certain other requirements. If you answer yes to at least one of the following questions, you may be covered for Medicare benefits.
• Are you 65 years old or above?
• If you are under 65, have you got some form of disability?
• Are you suffering from a kidney failure or end-stage renal disease that needs dialysis or transplant?
Medicare – Overview
Medicare comprises of 2 main categories such as the ‘original Medicare Plan’ and the ‘Medicare Advantage Plan’, and it is further broken down into 4 sub-categories such as parts A, B, C and D.
The Original Medicare Plan is composed of part A and you can add parts B and D to it. An individual gets automatically enrolled in the original plan, unless he/she chooses to opt for part C, which is Medicare Advantage Plan.
Medicare Advantage Plan or Part C is administered by private insurance companies and offers combined coverage of parts A and B. You can add part D in case the coverage is not offered. Medicare Advantage Plan accommodates Medicare special needs plan, fee-for-service plan, PPO and HMO.
Parts A, B, C & D – A Walk-Through
• Medicare Part A covers hospital insurance. Most individuals do not need to pay premium for getting this coverage. Part A offers coverage for in-patient care in skilled nursing facilities, hospitals and critical access hospitals.
• Medicare part B provides insurance for medically necessary services and supplies. Most individuals have to pay premium to get the coverage. Part B offers coverage for home healthcare, occupational or physical therapists, health care provider’s services and outpatient care.
• Part C combines parts A and B. The only difference is part C is offered by private insurance companies authorized by Medicare. If you enroll under part C, you may have to incur lower costs and receive additional benefits.
• Medicare part D is a stand-alone sub-category that covers prescription drugs. Getting covered under this part requires paying a premium. Part D offers various plans that cover different prescription medicines; however all the medically essential drugs are covered by all plans under Medicare part D. You should analyze and choose which plan caters best to your needs.
The ‘Original Medicare Plan’ doesn’t give you coverage for everything. You may have to bear certain costs, called as gaps, such as deductibles, co-pays and co-insurance, even though you are enrolled in Medicare. To cover these gaps, you will need to purchase ‘Medigap’ policy. You may consider another option, which is Medicaid. Medicaid is a combined program administered by federal and state governments, for covering medical expenses. Eligibility is decided based upon your income and the capacity to meet certain pre-requisites. Note that you should ask your healthcare provider if you are going to need any preventive services.
This was about – what does Medicare cover mean? I hope you found this post helpful!