What is Medicare?

Medicare is a health insurance program provided by the federal government and is available for individuals who are 65 and older, as well as younger people with disabilities or end-stage renal disease.

Medicare contains several parts, each of which provides coverage for specific medical needs. Original Medicare includes Part A (hospital coverage), Part B (medical coverage), and Part D (prescription medication coverage). Medicare Part C is known as Medicare Advantage.

Who Qualifies for Medicare?

As we mentioned above, an individual who qualifies for Medicare if he or she is 65 or older. Younger individuals can qualify for Medicare if they are permanently disabled or diagnosed with end-stage renal disease.

What Is The Purpose Of Medicare?

Medicare is available to make health coverage accessible to older Americans age 65 and over, including those who are traditionally retired and no longer have access to employer-based health insurance.

Medicare also provides coverage to those under 65 with certain disabilities to cover their health needs and associated expenses. These Americans often cannot work and don’t have access to employer coverage or other health insurance.

Types of Medicare

Medicare is divided into several parts, labeled from A to D:

• Medicare Part A is known as hospital insurance. It offers coverage for inpatient hospital care, lab tests, and surgery, as well as home health care and skilled nursing facilities. These services must be deemed medically necessary to be covered by Medicare. You may have to pay a deductible or coinsurance
• Medicare Part B is used for medical visits to a doctor. Medicare covers medically necessary services and preventive services. Each Medicare participant pays a monthly premium for Medicare Part B and there may also be deductibles and coinsurance that apply, depending on the care you receive
• Medicare Part C is known as Medicare Advantage. This isn’t part of Original Medicare but instead is an all-in-one replacement plan. Medicare Advantage plans include hospital coverage and doctor’s visits, along with prescription drug coverage. Many also offer additional benefits Original Medicare doesn’t cover, such as vision and dental care. However, you will often need to use medical professionals within the provider’s network. You’ll pay different copayments and deductibles with Medicare Advantage than with Original Medicare, which may allow you to save money. You may also have an additional monthly premium
• Medicare Part D is prescription drug coverage. It helps you pay for both brand-name and generic drugs, depending on your needs. The drug plans for Medicare are offered by insurance companies and other approved private companies. If you choose Medicare Part D, you will have a separate Part D premium each month

Medicare FAQ

In addition to the different types of Medicare, qualified individuals, caregivers, and loved ones often have questions about Medicare coverage. Here are some additional Medicare FAQ and answers.

What Does Medicare Cover?

Medicare covers a wide variety of healthcare services. The specific coverage depends on the Medicare policy you choose. Services covered by Medicare include but not limited to:

• Ambulance services
• Anesthesia
• Artificial eyes & limbs
• Bariatric surgery
• Blood processing & handling
• Cardiac rehabilitation programs
• Cardiovascular disease screenings
• Cervical & vaginal cancer screenings
• Chemotherapy
• Depression screenings
• Diabetes prevention programs
• Diagnostic tests (laboratory and non-lab)
• Eye exams (routine)
• Eyeglasses & contact lenses
• Flu shots
• Foot care
• GERD Surgery
• Hearing aids
• Hepatitis B and HIV screenings
• Inpatient hospital care
• Kidney transplants
• Lift chairs
• Lung cancer screenings
• Mammograms
• Mental health care (inpatient and outpatient)
• Occupational therapy
• Opioid use disorder treatment services
• Organ transplants
• Pain management
• Prescription drugs (outpatient)
• Preventive & screening services
• Radiation therapy
• Sexually transmitted infections screenings & counseling
• Sleep studies
• Surgery
• Urgently needed care
• X-rays
• Yearly "wellness" visits

Do I Need Medicare if I Already Have Health Insurance?

Whether or not you need Medicare if you already have health insurance depends on your individual medical needs. You may need Medicare even if you already have other health insurance if your current plan doesn’t meet the minimum coverage requirements.

Most plans offered by employers meet these standards. So if you have insurance through your job, you probably don't need Medicare. However, by staying on an employer plan, you can delay enrolling in Part B without a penalty and avoid paying Part B premiums.

An important note: When you have Medicare plus additional insurance policies, each provider becomes a "payer." The policy that pays for your specific medical services first depends on the coordination of benefits rules for your plans.

In other words, the primary payer will pay what it owes on your medical bills first, then the provider will send the remaining amount to the secondary payer to pay the rest.

What is the Difference Between Medicare and Medicaid?

Medicare is a federal health insurance program for older Americans and those with disabilities regardless of income. Medicaid is a state-based health insurance program for lower-income Americans that need help paying for medical care.

To learn more about costs, eligibility, and coverage, visit this guide to Medicare vs. Medicaid.

Who Do You Call for Medicare Questions?

If you have additional questions about Medicare and what it covers, you can call 1-866-955-0898 (TTY 711) to speak with one of our licensed insurance agents.

Agents are available Monday - Friday from 8am - 9pm and Saturday - Sunday 10am - 5pm ET.

Where Can I Get Free Medicare Advice?

For information on Medicare coverage, open enrollment, the different types of Medicare, and more, visit our Medicare learning center. For specific Medicare questions, contact us to speak with a licensed insurance agent.

Learn More About Medicare

Medicare is a valuable way to cover your healthcare costs if you are older or disabled. To compare your options and find the right Medicare plan in your area, visit our Medicare plans page today!