What is Medicare?
The majority of Medicare beneficiaries are 65 or older. Many in this group are automatically eligible and will have access to the Medicare services they want. However, there are some exceptions to the age requirement, like if someone has been diagnosed with a condition on Medicare’s list.
Medicare Is Health Insurance for Seniors
Medicare is health insurance for retirees and soon-to-be retired people. Provided by the government, Medicare’s coverage is revolutionary, allowing millions of seniors to access healthcare at a more affordable rate. There are different levels of Medicare coverage that extend to various areas of care.
Beneficiaries may choose between many different plans, which can give them access to certain treatments, cover their prescription drugs, reimburse home health expenses, and provide other benefits — depending on the program.
A Brief History Of Medicare
Did you know? Medicare was enacted in 1965 by President Lyndon B. Johnson. He approved a bill that allowed people age 65 and older to get the healthcare coverage they needed through a nationwide program.
In the early stages, the coverage was limited to “Original Medicare” parts A and B. But over time, the coverage changed and extended to help more people pay for their care.
Currently, over 56 million people are enrolled in Medicare. The programs continue to protect the health of American families and improve our economic security.
What Are the Parts of Medicare?
Medicare is divided into four parts: A, B, C, and D. They fit together in ways you may not expect.
Medicare Part A
We like to think of Part A as coverage for “room and board” in the hospital. In other words, it’s hospital coverage that helps you pay for inpatient care, and skilled nursing facility stays. Part A also covers hospice and home health care.
Most people get Part A premium-free and are automatically enrolled because they’ve paid taxes (for at least 10 years) that finance hospital premiums.
Medicare Part B
Part B is your outpatient medical insurance. It covers two types of services: medically necessary services and preventative services. Specifically, it covers treatments, ambulance services, clinical research, cancer and diabetes screenings, COVID-19 vaccines, flu shots, and much more. Most recipients pay the standard monthly premium for Part B, which is $174.70 in 2024.
In 2024, you also pay $240 for the Part B deductible. After you reach this deductible for the year, you normally pay 20% of the Medicare-approved amount for outpatient therapy, most doctor services, and durable medical equipment (DME).
Medicare Part C
Medicare Part C, known as Medicare Advantage, are health plans sold through private insurance companies approved by Medicare. It’s an alternative to Original Medicare which provides the same benefits, and may offer additional benefits like hearing, vision, dental, and certain prescription drugs. Many Part C plans have a $0 premium, although this doesn’t mean it’s “free.”
Common types of Advantage plans include HMO, PPO, MSA, PFFS, and SNP. Midwest Trusted Benefit can tell you what’s available in your area and help you choose the best Medicare Advantage plan for your situation.
Medicare Part D
Part D of Medicare is prescription drug coverage — making it easier for you to afford the medications you need. There are many Medicare drug plans available.
Part D is a standalone plan to be added to Original Medicare with a Medicare Supplement, while many Part C plans include drug coverage if you dedice to go that route.
Every Part D plan has a formulary or list of drugs it covers. An agent can help you compare plans and make sure your prescriptions will be covered.
What Medicare Doesn’t Cover
You should know that Medicare doesn’t cover EVERY expense. For example, it doesn’t pay for:
- Hearing aids
- Dentures
- Massage therapy
- Long-term care
- Medicare care outside of the U.S.
- Routine dental care
- Routine vision care
- Cosmetic and/or plastic surgery
The good news is that a Medicare Advantage plan or supplemental policy can help with SOME of these costs not covered by Original Medicare.
Medicare Can Be Overwhelming - Let Us Help
Let’s be honest. Medicare can be confusing, especially for people turning 65. The alphabetic parts A, B, C, and D, Medicare Advantage, Medigap, prescription drug plans, etc., can cause headaches for anyone. When you add things like VA coverage and employer coverage you’ve brought into retirement, the maze can get very complex. Having a broker like us to help you navigate the Medicare maze is important!
Midwest Trusted Benefit is here to answer your Medicare questions and ease your concerns. We’ll make recommendations that fit your budget while ensuring the plan covers the medical services you need. Why wait? Please book an appointment today.
