Medicare: Coverage and Health Management

Medicare

Medicare is a federal health insurance program that provides healthcare coverage at a small cost. Medicare is funded by the Hospital Insurance Trust Fund and the Supplementary Medical Insurance Trust Fund.

Who Qualifies for Medicare?

Nearly every medical facility in the United States accepts Medicare assistance. To qualify for Medicare, you must fall into one of the following categories:

  • Adults age 65 or older
  • Young people with disabilities
  • People with End-Stage Renal Disease

Coverage

Social Security enrolls you in Original Medicare. Although many people receive Medicare automatically, others must sign up.

We know that health care issues occur year-round, but there are certain times of the year (general enrollment period) when you must sign up or change how you receive coverage. Signing up when you are first eligible helps you avoid penalty. Be aware that there are three parts of Medicare:

  • Medicare Part A (Hospital Insurance) covers inpatient hospital stays, care in nursing facilities, and hospice care.
  • Medicare Part B (Medical Insurance) covers outpatient care, medical supplies, preventative services, and various doctors’ services
  • Medicare Part D (Prescription Drug Coverage) covers the cost of prescription drugs.

After determining your healthcare needs, decide how you will get your Medicare coverage. Two ways include:

  • Original Medicare includes Part A and Part B. You pay services as you go. At the beginning of the year, you will start out paying a deductible on each service. If you want prescription coverage, you can add a separate plan (Part D).
  • Medicare Advantage includes Part A, Part B, and Part D. This plan offers benefits not offered by the Original Medicare Plan.

Choosing a Primary Care Provider

Your primary care provider may be able to help you make health care decisions, which can improve how you manage your health care and lead to better results. By choosing a primary care provider on MyMedicare.gov, you have access to tools or services that are only available to patients of health care professionals participating in an Accountable Care Organization (ACO) or other Medicare alternative payment models (ACOs are groups of doctors, hospitals and other health care professionals working together to provide you high-quality, coordinated health care). Check with your primary care provider to learn if he/she is taking new Medicare patients.

For more information on Medicare, Medicare coverage, Medicare qualifications, and general enrollment, please visit: https://www.medicare.gov.

Source: Medicare.gov

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