Lesson 01: Medicare Overview
What Is Medicare?
Medicare is health insurance for the following:
- People 65 or older
- People under 65 with certain disabilities
- People of any age with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant)
Explore Medicare.gov for complete and up-to-date information about Medicare.
Most of the information in the Medicare section of our Resource Directory comes from the Medicare Web site.
The Different Parts of Medicare
The different parts of Medicare help cover specific services:
Medicare Part A (Hospital Insurance)
Medicare Part B (Medical Insurance)
- Helps cover doctors` services, hospital outpatient care, and home health care
- Helps cover some preventive services to help maintain your health and to keep certain illnesses from getting worse
Medicare Part D (Medicare Prescription Drug Coverage)
- A prescription drug option run by Medicare-approved private insurance companies
- Helps cover the cost of prescription drugs
- May help lower your prescription drug costs and help protect against higher costs in the future
Medicare Advantage Plans (like an HMO or PPO) are health plans run by Medicare approved private insurance companies. Medicare Advantage Plans (also called "Part C") include Part A, Part B, and usually other coverage like Medicare prescription drug coverage (Part D), sometimes for an extra cost.
Terms to keep in mind as you read about Medicare:
Deductible - The initial share of a medical or long-term care expense that consumers must pay before their insurance or the program will cover the expense.
Monthly Premium - The amount that is taken out of the Social Security check each month to pay for Part B Medicare. The amount is deducted from the check prior to an individual receiving the check.
Co-payment - The specific portion (dollar amount or percentage) that Medicare, health insurance, or a service program may require a person to pay towards his or her medical bills or services.
Benefit Periods - Medicare measures hospital and skilled nursing facility coverage in "Benefit Periods." A Benefit Period begins the day a person is admitted to the hospital and ends after he/she has been out of the hospital and/or skilled nursing facility for 60 consecutive days. Should the patient return to the hospital within those sixty days, he/she is still within the original Benefit Period. Should the patient return to the hospital after those sixty days are over, a new benefit period begins.