Explanation of Medicare Benefits

More than 40 million Americans enjoy the benefits of the Medicare program, a publicly funded health care program for the elderly and people with disabilities. To be eligible you must be a citizen of the United States and either 65 years old or older; suffering from certain disabilities, or suffering from End-Stage Renal Disease. Medicare has four major plans: Medicare Part A, Medicare Part B, Medicare Part C and Medicare Part D.

Medicare Part A

Medicare Part A covers short-term, noncustodial inpatient care at hospitals, critical access hospitals and skilled nursing facilities, as well as hospice care and home health care. Most people do not have to pay a premium for Part A. Medicare does not offer full coverage for these services, but it will help offset many of your expenses.

Medicare Part B

Medicare Part B covers medical tests, preventive medicine, physicians’ services and certain other expenses. It covers some of the “gaps” in Medicare Part A, but even in combination with Medicare Part A, it does not provide complete health care coverage. Most people have to pay a premium for Medicare Part B, although it is typically less than $100 per month. Certain enrollment windows apply, and if you miss them your premiums will increase.

Medicare Part C (Medicare Advantage Plan)

Medicare Part C is a combination of Medicare Part A and Part B, plus certain specialized medical services and prescription drugs. It is offered by Medicare-approved private insurance companies. You must generally use approved hospitals and doctors, and medical care availability is greatly restricted outside of your geographical coverage area. You will have to pay a premium, and some Medicare Part C plans allow you to choose your own doctors for an increased premium. In order to be eligible, you must already be enrolled in Part A and Part B, and not have End-Stage Renal Disease.

Medicare Part D

Medicare Part D is provided by private Medicare-approved health care service providers. It covers prescription drugs. There are two main ways to enroll: By adding Medicare Part D to your existing Medicare Part A plan, or by joining a PPO or HMO that offers Medicare Part D. You probably do not need Part D if you are already enrolled in Part C. You will have to pay a separate premium for Medicare Part D.

Co-Payments and Deductibles

Co-payments are small payments–around $20–that you must pay every time you receive a medical service. Deductibles are set amounts that you must pay before Medicare coverage kicks in, sometimes amounting to several hundred dollars per year.