Basics and Parts of Medicare

medicare written

Medicare is the federal health insurance program for the people who are 65 years old or above, for those younger people with some kind of disabilities, and people with End- stage Renal Disease(permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)

The program was started in 1965. It plays a key role in providing health and financial security to 60 million older people and younger people with disabilities in USA. The program helps to pay for many medical care services, including hospitalizations, preventive services, skilled nursing facility and home health care, and hospice care. It also covers many health services, including inpatient and outpatient hospital care, physician services, and prescription drugs.

Parts of Medicare: Medicare Program is being divided into 4 parts which are being described as follows:

Part A : It covers inpatient hospital stays, skilled nursing facility (SNF) stays, some home health visits, and Hospital care. The benefits are subject to a deductible ($1,364 per benefit period in 2019). It also requires coinsurance for extended inpatient hospital and SNF stays.

Part B : It covers physician visits, outpatient services, preventive services, and some home health visits. The benefits are subject to a deductible ($185 in 2019), and, typically, coinsurance of 20 percent. No coinsurance or deductible is charged for an annual wellness visit or for preventive services that are rated ‘A’ or ‘B’ by the U.S. Preventive Services Task Force, such as mammography or prostate cancer screenings.

Part C: It refers to the Medicare Advantage program, through which beneficiaries can enroll in a private health plan, such as a health maintenance organization (HMO) or preferred provider organization (PPO), and receive all Medicare-covered Part A and Part B benefits and typically also Part D benefits. Enrollment in Medicare Advantage plans has grown over time, with more than 20 million beneficiaries enrolled in Medicare Advantage in 2018, or 34 percent of all Medicare beneficiaries.

Part D: It covers outpatient prescription drugs through private plans that contract with Medicare, including stand-alone prescription drug plans (PDPs) and Medicare Advantage plans with prescription drug coverage (MA-PDs). In 2019, beneficiaries have a choice of 27 PDPs and 21 MA-PDs, on average. The Part D benefit helps pay for enrollees’ drug costs and provides coverage for very high drug costs. It also provides additional financial assistance for beneficiaries with low incomes and modest assets. Enrollees pay monthly premiums and cost sharing for prescriptions, with costs varying by plan.


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