What is Medicare?
What is Medicare?
Medicare provides healthcare at low costs, with benefits such as hospitalization, medical coverage, and more.
Within the broad category of Medicare, there are four parts—Part A, B, C, and D.
What Coverage is Included in Original Medicare?
When asking the question “what is Medicare?”, one of the most important answers is the coverage that is included. Part A coverage includes:
- Hospital Inpatient Care
- Nursing Facility Care
- Nursing Home Care
- Hospice Care
- Home Health Services
Parts A and B are, more often than not, purchased together. They are coupled together because they are both included in the category of Original Medicare, and because they are both required to enroll in any additional Medicare coverage.
So, with coverage through Part B, your benefits will also include:
- Cardiac Rehabilitation
- Limited Chiropractic Services
- Ambulance Services
- Diabetes Supplies
- Durable Medical Equipment (DME)
- Kidney Dialysis Services and Supplies
- Outpatient Mental Healthcare
- Physical Therapy
- And Much More
What are the Medicare Eligibility Requirements?
Medicare is an insurance program targeted towards eligible individuals. But who is eligible? To enroll in Medicare, you must meet at least one of these requirements:
- Be 65 Years Old or Older
- Have End-Stage Renal Disease (ESRD), Lou Gehrig’s Disease, or ALS
- Have Received Social Security Disability Benefits for at Least 24 Months
You will either be automatically enrolled or have to apply. Either way, when you first become eligible by age, you will have 7 months to enroll starting three months before your 65th birthday, the month of, and three months after.
This is referred to as your Initial Enrollment Period (IEP). If, however, you are eligible for Medicare based on a disability or qualifying illness, you can apply at any time (regardless of age) known as a Special Enrollment Period (SEP).
What is Medicare Advantage?
Medicare Advantage (Part C) is an all-in-one alternative to Original Medicare. It will, no matter what, include all of the benefits included in Parts A and B, as well as a variety of additional benefits.
The main function of Part C is to coordinate your healthcare services and lower your out-of-pocket costs. Unlike the other basic Medicare plans, these plans are offered through third-party insurers.
Specific benefits will vary depending on the provider. No matter what, however, plans will all follow one of four structures of coordination:
- Special Needs Plans (SNPs)
- Preferred Provider Organization (PPO) Plans
- Health Maintenance Organization (HMO) Plans
- Private Fee-for-Service (PFFS) Plans
What is Medicare Part D?
Medicare Part D, like Original Medicare, is a federal health insurance program. This plan can actually be added to your Original Medicare coverage, but not if you have an Advantage plan.
However, more often than not, these plans already include prescription drug coverage—and that is exactly what Plan D has to offer.
If you need medicine without prescription drug coverage, you may end up paying hundreds or even thousands out-of-pocket. With Part D, depending on the type of prescription, you will only pay $1-$30 or a percentage of the total cost.
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We’re here to get you the insurance coverage you need. We’re trained, able, and ready to answer all of your Medicare questions. If you’re ready to get started, call Texas Medicare Advisors at 512-900-3008