Medicare Benefits

Medicare is the federal health insurance program for people 65 years of age and older. It also covers individuals with certain disabilities who are not yet 65, and anyone with End-Stage Renal Disease who requires dialysis or a kidney transplant. Medicare benefits include Parts A, B, C and D. Monthly premiums, where applicable, are based on income. Parts A and B are the original Medicare program. Part C functions similar to an HMO or PPO. Part D covers only prescription drugs. A one-time “Welcome to Medicare” physical exam is available to all recipients.

Medicare Part A is hospital insurance which covers inpatient hospital care, temporary stays at a skilled nursing facility, and home health or hospice services. People who paid Medicare taxes while working usually pay no premium for Part A Medicare benefits. Those ineligible for no-cost coverage who meet other eligibility requirements, may purchase Part A but usually must also have Part B, which requires a separate monthly premium.

Medicare Part B is medical insurance which covers physician, outpatient, ambulance and other medical services. Preventive services such as flu shots and some screenings or tests are also included. Most recipients pay the standard monthly premium, although higher income seniors will pay more. There is also an annual deductible for Part B Medicare benefits. Once the deductible is met, patients usually pay 20% for covered services if received from providers who accept the amount approved by Medicare.

Medicare Part C, known as a Medicare Advantage Plan, includes both Parts A and B. Provided by private insurance companies, individuals choosing Part C coverage must use certain providers or pay more for services. Benefits, costs and rules vary by plan and an additional monthly premium for Part C coverage is usually required.

Medicare Part D is prescription drug coverage. Provided by private insurance companies, individuals must elect to join Part D and pay an additional premium. Certain plans allow eligible low-income seniors with limited resources to have premiums paid for them.

Depending on location, income and resources, financial assistance may be available through state or other programs to help pay some or all of the costs of receiving Medicare benefits.

In addition to health services, Medicare benefits also include free information booklets on a variety of health-related topics. How to choose a nursing home, hospice care, mental health care and prescription drug coverage are just a few of the covered subjects.

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