Medicare Definition


Medicare is a national health program funded by the United States federal government. The idea of this program originally came into establishment in 1912. Its main purpose was to provide health insurance coverage for senior Americans who could not afford healthcare treatment. At that time, most Americans were barely affording treatment after retirement. However, it was until 1965 that President Johnson signed Medicare into law. Today, the program covers more than 62 million American citizens. The health insurance program consists of four plans. This has been an improvement since the time its operations began. Currently, it encompasses parts A, B, C, and D. Besides seniors older than 65; the insurance also covers other groups with specific health complications.

Who is Eligible for Medicare?

Three groups of individuals are eligible for Medicare.

1. Seniors who are 65 years or older
Individuals 65 years or older must be American citizens to qualify for Medicare benefits. They must also be receiving benefits from Railroad Retirement Board or Social Security. If not, an individual or the spouse must have worked long enough to pay Medicare taxes.
2. Younger people with disabilities
Individuals younger than 65 qualify for Medicare benefits if they have a disability pension from the Railroad Retirement Board. People that have paid for Social Security disability services for at least two years can also enroll in Medicare. Another exception is a person with amyotrophic lateral sclerosis.
3. Individuals with permanent kidney failure

Medicare Cover Choices

Part A

Also known as hospital insurance, Medicare Part A covers hospice care, inpatient hospital services, skilled nursing care, and home healthcare.

Hospice Care: This service provides comfort care for patients at the end of life. Healthcare providers introduce hospice care when patients no longer respond to treatment methods intended to cure a disease or suppress its progress.
• Home Health care: Home-based care insures professional healthcare services you receive in the comfort of your home. It caters to diverse conditions. Although home care is less expensive than hospital care, it is similarly beneficial.
• Inpatient Hospital Service: It covers admitted patients. Medicare insurance pays for up to 90 days of hospital stay. The benefits included under inpatient hospital service are meals, general nursing, rooms, prescription drugs, and hospital supplies needed by healthcare providers for delivering treatment.
• Skilled Nursing Care: Skilled Nursing Care is provided only by licensed healthcare specialists. Medicare covers for up to 100 days. The plan offers a wide range of services like blood transfusion, tube feedings, occupational therapy, speech therapy, physical therapy, and diabetes management, to mention a few. 

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Medicare Part A Cost

Premium-free Part A

Usually, there is no need to pay for Part A coverage. Nevertheless, this only applies to;
1. Persons receiving or eligible for Social Security or Railroad Retirement benefits
2. Folks that have paid Medicare taxes for a specific period
3. Individuals with or have spouses who have Medicare-covered occupations. 

Paid Premium Part A

You will have to make monthly premium payments if you do not qualify for the Premium-free Part A plan. Currently, the monthly payment is $274 or $499. This depends on how long you paid the Medicare taxes. Alternatively, you can purchase the Medical Insurance plan (Part B).

Part B (Medical Coverage)

Medicare Part B Benefits
• Ambulance services
• Outpatient services
• Preventive care
• Mental health services
• Medical equipment
• Emergency room services
• Chemotherapy
• Kidney dialysis
• Transplants

Part B Monthly Cost

The monthly premium for Medicare Part B as of 2022 is $170, the standard amount. Most people prefer the standard pay. However, the monthly cost depends on one’s yearly income; other individuals may pay more than the average monthly premium. Typically, Medicare determines the monthly cost based on the gross income on IRS tax returns from two years back. The Medicare deductible for the Part B plan is currently $233. When you meet the deductible, you can pay coinsurance, roughly 20% of total Part B coverage. 

Medicare Part C

Part C is typically the Medicare Advantage plan. Individuals under Parts A and B automatically qualify for Medicare Advantage. This plan is under the provision of private insurers approved by Medicare. Although people purchase Medicare Advantage plans via private insurers, the companies follow the rules set by the government Medicare. Medicare Part C has several benefits as it may cover many healthcare services not covered by the Original Medicare plan.

Medicare Advantage Services

  • Special Needs Plans

This Medicare Advantage plan ensures targeted treatment for people with unique healthcare needs. Persons with permanent disabilities and chronic illnesses fall under this group. SNPs offer you a chance to choose your most preferred healthcare provider. 

  • Preferred Provider Organizations

PPOs is a plan that offers healthcare procedures provided by a network of physicians, medical facilities and other groups of health experts that partner with your insurance company. 

  • Health Maintenance Organizations

HMO is a health cover that allows for health service provision by doctors, medical facilities, and other healthcare professionals in one network. 

  • Private Fee-for-Service Plans

.This is a Part C plan offered by a private company with a yearly Medicare contract. Since the private insurer is at risk of financial loss, it dictates the amount it will pay for health services. For that reason, consumers must receive treatment from providers with no issue with the set Medicare plan coverage.

Medicare Advantage Cost

The average cost of Medicare Advantage Premium is $19 as of 2022. However, most Part C plans do not require any monthly or yearly payment. You may only need to pay varying amounts if you prefer providers in different networks or need more benefits, among other factors. 

Medicare Part D

Medicare Part D covers prescription drugs. You can get this coverage by enrolling in Medicare drug plans or Medicare Advantage. Medicare Part D covers a wide range of prescription medications, including drugs for chronic illnesses such as HIV/AIDS and cancer.

Medicare Part D Cost

Drug coverage costs vary depending on certain factors.
• The enrolled Medicare drug plan
• The type of prescription
• Drug formulary
• Healthcare network

Medicare Supplemental Insurance

Also known as Medigap, it is provided by private insurance organizations. Medigap covers healthcare services not offered by the Part A and B plans. It may help clear deductibles, coinsurances, and copayments.

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Medicare Definition
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