How Does Medicare Work?

How Does Medicare Work?

In the US, Medicare is among the most common sources of health insurance in the nation. It accounts for 18% of US health insurance business and keeps over 60 million people cared for and healthy. Anyone approaching or within retirement age or with certain medical conditions may find themselves as future Medicare accountholders. But what exactly is Medicare, and how does it work to provide the health services you need?

What is Medicare?

Medicare is the universal healthcare program offered to people over the age of 65 and with certain medical conditions. It ensures that those members of our population most in need of healthcare have a source, even (and especially) when they are unable to work. Medicare offers multi-part coverage and you can sign up altogether as a package or one part at a time.

How does Medicare work?

To receive Medicare, confirm your eligibility and submit a formal application to receive coverage. Sign up for Part A and Part B at the same time, sometimes with Part D included, sometimes as a follow-up document. Original Medicare allows you to visit any provider who accepts Medicare coverage. However, if you get a specialty plan from, for example, an employer you may be limited to approved local medical providers in trade for more total coverage.

What’s the difference between Medicare and Medicaid?

To quickly clear up a common FAQ, the difference between Medicare and Medicaid. Medicare is a federal source of health insurance for post-retirement age. Medicaid offers additional lifestyle coverage like home nursing and Medicare out-of-pocket assistance for those in economic need. In simplest terms, Medicaid helps people to afford Medicare.

Parts of Medicare

Medicare is separated into four general categories and you’ll hear about these categories a lot when talking or reading about Medicare. They are Parts A, B, C, and D, each representing an essential piece of Medicare and applied or configured in a different way. Parts A and B are most often paired, while most health plans are built out of Part C, consisting of Parts A, B, and D. However, you are most likely to find a separate plan for Part D alone.

Part A: Hospital Insurance

Part A provides coverage and co-pay should you or a covered loved one need hospital care. It offers insurance coverage for hospital visits, nursing facilities, hospice care, and home health care.

Part B: Medical Insurance

Part B of Medicare covers standard health insurance. It covers services from doctors and other providers, outpatients care and medical equipment, preventative medical services. and home health care. If you need to see a doctor or pursue prescription care, Part B Medicare can or should cover services you need with the usual split for covered and premium out-of-pocket costs.

Part C: Medicare Advantage

Part C is how companies and organizations can build their own health plans that work through the Medicare service network. Medicare Advantage is a framework that lets companies combine Part A, Part B, and sometimes Part C with their own custom configurations and balance of co-pay. This helps health networks to offer customized health care plans through Medicare.

Part D: Drug Coverage

Part D is drug coverage. It determines how much you pay for your prescriptions and which ones are covered by your policy. Usually, you sign up for Part A and Part B, then you can decide if you want Part D through the same plan or something separate and custom. Some people only get Part D coverage and just for their current prescriptions.

Medigap: Supplemental Insurance

Finally, there’s Medigap which helps expand your Medicare coverage beyond your original plan and cover any specific needs you may have. Any supplemental services that help create full coverage from Medicare’s almost-complete design falls within the Medigap policy.

Healthcare Solutions Team is a wholly-owned subsidiary of the National General Insurance Group and The Allstate Insurance Company. Contact us today to further explore your Medicare account, policy, and options.