Medicare is a health insurance program that provides healthcare benefits for people 65 years and older, younger people with certain disabilities, and people of any age with permanent kidney failure or end-stage renal disease (ESRD) requiring dialysis or a kidney transplant. What are the different parts of Medicare?
Medicare Part A (Hospital Insurance) helps to covers: inpatient hospital stays, care in a skilled nursing facility, hospice care, and Home health care. Medicare Part B (Medical Insurance) helps to cover: services from doctors and other health care providers, outpatient care, durable medical equipment, and some preventive services. Medicare Part C (Medicare Advantage Plans) are plans offered by Medicare -approved private insurance companies. These plans include all benefits and services covered under Part A and Part B. and may include extra benefits and services for an additional cost. Medicare Advantage Plans include HMO Plans, PPO Plans, PFFS Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. Most Medicare services are covered through the Medicare Advantage Plan and not under Original Medicare. Most Medicare Advantage Plans includes prescription drug coverage (Part D) Medicare Part D (Prescription drug coverage) 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 Medicare-approved private insurance companies. Medicare Advantage Plans may also offer prescription drug coverage that has the same rules as Medicare Prescription Drug Plans. What are my Medicare coverage choices?
There two main ways to get your Medicare benefits - Original Medicare or a Medicare Advantage Plan. Under Original Medicare, you can go to any doctor, hospital or facility that accepts Medicare. There are no networks, and there is no need to choose a primary care physician, nor do you need a referral to see a specialist. Medicare, however, does not cover everything, and it does not pay the total cost for most services and supplies that are covered. Original Medicare has deductibles, copayments, and coinsurance which is the patient's responsibility. Many people purchase a Medicare Supplement (known as Medigap) that helps to pay for some of the deductibles, coinsurance and copayment costs that Medicare does not cover. Also, Original Medicare does not cover prescription drug costs, but you can purchase a Part D drug plan to cover these costs. The other way is by enrolling in a Medicare Advantage Plan (Medicare Part C)which is a form of managed care, like an HMO or PPO. These plans are sometimes referred to as Medicare replacement plans. If you’re in Medicare Advantage plan, you generally must go to doctors and other providers in the plan's network. If you go out of network, you may have to pay more. On the other hand, Medicare Advantage companies may offer some additional benefits – such as dental, hearing, vision and wellness programs and gym membership – that Original Medicare doesn’t. As mentioned above, most Medicare Advantage Plans includes prescription drug coverage (Part D).
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