MEDICARE BASICS - 1

Question 1

What you need to know about Medicare before speaking with an agent

Answer 1

Medicare is a government national health insurance program in the United States, begun in 1965 under the Social Security Administration (SSA) and is now administered by the Centers for Medicare and Medicaid Services (CMS). It primarily provides health insurance for Americans aged 65 and older but also for some younger people with disability status as determined by the SSA, including people with end-stage renal disease and amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease).

Question 2

Medicare Basics:

Answer 2

Medicare is divided into four Parts: A, B, C and D. Part A covers hospital, skilled nursing, and hospice services. Part B covers outpatient services. Part D covers self-administered prescription drugs. Additionally, Part C is an alternative that allows patients to choose their own plans that provide the same services as Parts A and B, but with additional benefits.

Question 3

PART A

Answer 3

Part A covers hospital (inpatient, formally admitted only), skilled nursing (only after being formally admitted to a hospital for three days and not for custodial care), and hospice services.

Question 4

PART B

Answer 4

Part B covers outpatient services including some providers’ services while inpatient at a hospital, outpatient hospital charges, most provider office visits even if the office is “in a hospital”, and most professionally administered prescription drugs.

Question 5

PART C

Answer 5

Part C is an alternative called Managed Medicare or Medicare Advantage, which allows patients to choose health plans with at least the same service coverage as Parts A and B (and most often more), often the benefits of Part D, and always an annual out-of-pocket expense limit which A and B lack. A beneficiary must enroll in Parts A and B first before signing up for Part C.

Question 6

PART D

Answer 6

Part D covers mostly self-administered prescription drugs.

Question 7

MEDICARE SUPPLEMENT

Answer 7

If you have Original Medicare Parts A and B, you can go to any doctor or hospital accepting Medicare as payment for their services if enrolled in original Medicare. However, outside of preventive screenings and tests usually covered under Part B of your original Medicare plan, you may need additional coverage to help pay for treatments not covered by Part A or Part B.

This could involve enrolling in a Medicare supplement policy such as Medigap or a private provider-offered policy like an Advantage Plan or a stand-alone prescription drug plan like Part D to help bridge the gaps of coverage not provided under original Medicare.