Government Programs

What is Medicare

The official (US Government) definition of Medicare is - the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).

What you need to know from that definition is that since you are now recognized as disabled by the government – because you signed up for Social Security disability you qualify for the federal health insurance program of Medicare. Medicare works in tandem with state run Medicaid –Medicare typically is the first umbrella under which you will be covered.

So, Medicare will be the first organization to pay for a visit to your family doctor for a stomachache, an x-ray of your ankle in the ER, or a prescription for muscle spasticity. They cover a large chunk of your costs, but everything you do must be recognized by Medicare to be covered within it – especially medications. Find out what is covered here.

Medicare is separated into four components. Each component covers a separate area of the healthcare industry. It is possible to pick and choose components individually but it is common to have a preset combination. The Medicare website is actually pretty helpful in choosing what is best for you, it is the best tool to identify what you specifically need. Go here to find out.

Here is a breakdown of the four components of Medicare - here:

Part A (official info)- helps pay for hospital and facility costsThis includes things like a shared hospital room, meals and nurse care. It can also help cover the cost of hospice, home health care and skilled nursing facilities.
Part B (official info) - helps pay for medical costsThis is care that happens outside of a hospital. It includes things like doctor visits and outpatient procedures. It also covers some preventive care, like flu shots.
Parts A and B together are called Original Medicare. These two parts are run by the federal government.
Part C (official info) – these are Medicare plans. They are run by private companies and combine both Part A and Part B.  There are multiple plans each with their own benefits. This is basically a private health plan that Medicare recognizes.  They’re called Medicare Advantage plans. They cover everything Parts A and B cover, plus more. They usually cover more of the costs you’d have to pay for out of pocket with Medicare Parts A and B. Part C plans put a limit on what you pay out of pocket in a given year, too. Some of these plans cover preventive dental, vision and hearing costs. Original Medicare doesn’t.
Part D (official info)- helps pay for prescription drugs.  They cover commonly used brand-name and generic drugs. Some plans cover more drugs than others.

The cost for each component vary dramatically. For a quick idea on what you could pay - go here.
Okay, those are the four pieces of Medicare. You will use some combination of those four, most likely a Medicare advantage plan and Part D prescription drug coverage. This will be a main support for your future healthcare needs.

Next step–go to the Medicare website to decide what you need. Then go to our Medicaid portal and sign up for that. Have fun.

Video: The Story of Medicare - a Timeline

 

Takeaway Points:

  • Medicare is reserved for those over 65 or disabled
  • Medicare typically covers primary costs before Medicaid
  • Medicare Part A pays for hospital and rehab costs
  • Medicare Part B pays for medical costs

Helpful Links: