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).
Medicare is a federal insurance program. Medical bills are paid from trust funds which those covered have paid into. It serves people over 65 primarily, whatever their income; and serves younger disabled people and dialysis patients. Patients pay part of costs through deductibles for hospital and other costs. Small monthly premiums are required for non-hospital coverage. Medicare generally functions the same everywhere in the United States and is run by the Centers for Medicare & Medicaid Services (CMS), an agency of the federal government.
The different parts of Medicare help cover specific services
Medicare Part A (generally no premium payment needed, Hospital Insurance)
Part A (Hospital Insurance) helps cover:
- Inpatient care in hospitals
- Skilled nursing facility (SNF) care for a limited time
- Hospice care
- Home health care
Medicare Part B (Medical Insurance, a premium is generally required)
Medicare Part B covers
- certain doctors’ services
- outpatient care
- medical supplies
- Preventive services
People pay a standard monthly Part B premium. Note: You may want to get coverage that fills gaps in Original Medicare coverage. You can choose to buy a Medicare Supplement Insurance (Medigap) policy from a private company.
Medicare Part C (Medicare Advantage Plans)
A type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations (HMO’s), Preferred Provider Organizations (PPO’s), Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans.
NOTE: If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan and aren’t paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage. Advantage Plans DO NOT need to follow all of the Medicare guidelines when determining care limits or offerings. If you have an Advantage plan, you DO NOT have traditional Medicare. You have agreed to allow a third party company to manage your Medicare benefits
Medicare Part D (prescription drug coverage)
Part D adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans. These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.
Not sure what kind of coverage you have?
- Check your red, white, and blue Medicare card.
- Check all other insurance cards that you use. Call the phone number on the cards to get more information about the coverage.
- Check your Medicare health or drug plan enrollment.
- Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.