What is Medicare? 

Medicare is the federal health insurance program for people 65 and over, some younger with disabilities and those with End Stage Renal Disease.  Medicare is a different program from Medicaid, which offers healthcare and services to those who meet the qualified lower income requirements. Anyone receiving Social Security Disability (SSDI) for 24 months, will also become eligible for Medicare.
There are 4 main parts of Medicare and each part works in a unique way to help cover your healthcare expenses.

Parts of Medicare:
Medicare Part A is inpatient and hospital insurance. Part A helps cover:
Inpatient hospital care
Skilled nursing facility care
Hospice care
Some home health care
Medicare Part B is outpatient medical insurance. Part B helps cover:
Services from a doctor
Outpatient care
Durable medical equipment
Preventative services
Some home health care
Medicare Part C (Medicare Advantage) are privately managed, federally approved Medicare plans.
Part C plans combine the benefits of Part A and B into one plan and may also include:
Prescription drug coverage
Dental, vision, and hearing coverage
Wellness programs and telehealth services
Medicare Part D plans provide beneficiaries with privately managed, federally approved prescription drug coverage.
Medicare Part A and B do not offer prescription drug coverage, so Part D helps:
Manage prescription drug costs
Provide lower cost-sharing for in-network and preferred pharmacies

 

 

 

 

What does Medicare Pay:

Medicare generally covers 80% of your Part A and Part B medical costs.  You are responsible for the remaining 20%. There is no limit on what you pay out of pocket, unless you have Medicare Supplement coverage, also known as Medigap. You could also choose to get your coverage through a Medicare Advantange plan, also known as Part C.  It is important to understand how each of these coverages work, when making a decision on how you would like to receive your benefits.  
New to Medicare with Employer Coverage:
There are several factors to consider if it makes sense to keep your employer coverage alongside your Medicare or would it be better to leave the employer coverage and choose Medicare as your primary insurance.
A few key questions would include: How large or small is the employer? How much is your monthly premium?  Do you perfer a network based plan or would you like to have more freedom to choose any provider that accepts Medicare?
When it comes to Medicare, there is no one size fits all.  Knowing your situation and what you find important, provides answers that help determine which road may be more suitable for you.

 

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