Medicare 101

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Medicare is the federal government program that provides health care coverage if you are 65+, under 65 and receiving Social Security Disability Insurance for a certain amount of time, or under 65 and with End-Stage Renal Disease.

Once you have become Medicare-eligible and enroll, you can choose to get your Medicare benefits from Original Medicare, or from a Medicare Advantage Plan, a type of private insurance offered by companies that contract with Medicare (the federal government).

What is the original Medicare?

Original Medicare consists of Part A and Part B. If you have Original Medicare, the government pays directly for the health care services you receive. Additionally, enrolling in Original Medicare means:

• You will receive a red, white, and blue Medicare card to show to your providers

• Most doctors in the country take your insurance

• Medicare limits how much you can be charged if you visit participating and non-participating providers, but it does not limit how much you can be charged if you visit providers who opt out of Medicare

• You can see a specialist without prior authorization

• You are responsible for Original Medicare cost-sharing, which may include premiums, deductibles, and coinsurances

• You are eligible to enroll in a Medigap policy, which can help reduce your out-of-pocket costs

Part A

In general, Part A covers:

• Inpatient care in a hospital

• Skilled nursing facility care

• Nursing home care (inpatient care in a skilled nursing facility that’s not custodial or long-term care)

• Hospice care

• Home health care

Part B

Part B covers 2 types of services Medically necessary services:

• Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.

• Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.

Source: https://www.medicare.gov/

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EPIA inc. is a private Insurance Agency with no ties with legal entities. The information contained in this article is based on information provided by the Medicare Official Website.