• It is a Federal/National health insurance program. It’s run by a federal agency called CMS (Centers for Medicare and Medicaid Services).
• This insurance covers people who are 65 or older. People under 65 who have disability, ESRD (End Stage Renal Disease), or ALS may be eligible for Medicare.
•  Because Medicare is a Federal Program, it has set standards for costs and coverage. This means:
  • A person’s Medicare coverage will be the same no matter what state they live in
  • What people pay for Medicare will vary based on what coverage (Part A, B, C, D) and services they opt for.
  • There is no yearly limit for out-of-pocket costs. You can lower out-of-pocket costs by
    • having a supplemental insurance (Medigap) if you have opted for Original Medicare
  • • or can opt for a Medicare Advantage Plan (Part C)

Parts of Medicare

Mostly defined by 3 parts: A, B, and D.

Part A (Hospital Insurance)

Part A helps cover:

• inpatient care in hospitals,
• skilled nursing facility care,
• hospice care, and
• home health care.

Part B (Medical Insurance)

Part B helps cover:

• Services from doctors and other health care providers
• Outpatient care
• Home health care
• Durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment)
• Many preventive services (like screenings, shots or vaccines, and yearly “Wellness” visits)

Part D (Drug coverage)

Part D helps cover the cost of prescription drugs (including many recommended shots or vaccines). You join a Medicare drug plan in addition to Original Medicare, or you get it by joining a Medicare Advantage Plan with drug coverage. Plans that offer Medicare drug coverage are run by private insurance companies that follow rules set by Medicare.

Medicare Supplemental Insurance (Medigap)

Extra insurance you can buy from a private company that helps pay your share of out-of-pocket costs in Original Medicare. Policies and benefits are standardized, no matter which insurance company sells the plan.

There are 2 main ways to get a Medicare coverage option

When you first sign up for Medicare and during certain times of the year, you can choose which way to get your Medicare coverage. There are 2 main ways:

Original Medicare

• Original Medicare includes Part A and Part B. It is a federal plan.
• You can join a separate Medicare drug plan to get Medicare drug coverage (Part D).
• You can use any doctor or hospital that takes Medicare, anywhere in the U.S.
• You can buy a Medical Supplemental Insurance policy (Medigap) that helps lower your out-of-pocket costs (like your 20% coinsurance).

Medicare Advantage (also known as Part C)

• Medicare Advantage is a Medicare-approved plan from a private company that offers an alternative to Original Medicare for your health and drug coverage. These “bundled” plans include Part A, Part B, and usually Part D.
• In many cases, you can only use doctors who are in the plan’s network.
• Can’t buy separate supplemental coverage (like Medigap).
• Plans often have different out-of-pocket costs than Original Medicare or supplemental coverage like Medigap. You may also have an additional premium.
• Plans may offer some extra benefits that Original Medicare doesn’t cover — like vision, hearing, and dental services.