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 What is Medicare?

Medicare is the government-run health insurance program designed to provide medical insurance for eligible people over 65 and people with disabilities and certain chronic illnesses. Medicaid is a similar program designed for low-income people. Generally, all citizens 65 and older are eligible for Medicare benefits. In 2010, Medicare helped insure more than 48 million Americans.  Eligible persons can choose the level of coverage, called Parts A through D; they wish to receive under Medicare. This flexibility allows people to supplement their Medicare coverage with private insurance or refuse Medicare benefits all together.  

Created in 1967, the original Medicare consists of two parts. Part A covers hospital care and most expenses related to an extended hospital stay, as well as rehabilitation and skilled home nurse care. Part B covers up to 80% of the cost of doctor visits, outpatient care, durable medical equipment, and medical services not covered in Part A.  In 1997, Congress created Medicare Part C, also known as Medicare Advantage, which combines Parts A and B and gives people even more options. Medicare Advantage Plans are offered through private insurers known as Medicare Advantage Organizations (MAO). Medicare covers only a fixed amount of monthly premiums, but Part C offers more benefits, such as dental care and wellness programs.  Medicare Part D was created in 2006 to meet the rising costs of prescription drugs. Eligibility requirements are the same for Parts A and B, but although administered by the federal government, Medicare Part D is paid for by private insurers, so individual plans can have restrictions.  

Rules and restrictions regarding Medicare are constantly changing, so knowing the latest regulations can help you better decide which Medicare plan is best for you. No Medicare plan covers every out-of-pocket expense, so knowing what your insurance actually covers and how much it costs can help you decide if supplemental insurance is necessary to meet your healthcare needs.

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Medicare Health Insurance Is Supplemented by Medicare Advantage Plans

To help cover the gaps in coverage in the original Medicare, the government has added several health insurance plans that often lead to confusion. Medigap is private health insurance you can purchase to cover what your Medicare plan does not, such as the 20% co-pay for doctor visits.  Ten types of standardized Medigap policies are available from a wide range of private insurers. However, each insurance company charges different rates for the same benefits, so it pays to shop around for the best Medigap policy rates.   

Unlike Medigap plans, Medicare Advantage plans are designed to do more than cover the gaps the original Medicare left behind. Medicare Advantage usually includes all of Parts C and D, but you have many more options about the kind of coverage you receive and where that coverage may be available.  Medicare Advantage plans are available in many different types, such as health maintenance organization (HMO) plans, private fee-for-service (PFFS) plans, preferred provider organization (PPO) plans, and medical savings account (MSA) plans.  Each Medicare Advantage plan offers different types of services and varied payment tiers and with different restrictions, such as whether you will need a referral to see a specialist outside your provider network. Some plans charge monthly premiums while others charge annual premiums. Some cover all Part B expenses while others require higher deductibles.


Important Facts to Know About Medicare Health Insurance

Knowing your rights and eligibility can help you live a longer and healthier life, with fewer worries about routine medical care and more time to enjoy yourself. Medicare and its supplemental plans can play an important role in your health care if you know what benefits are available and how to get them.  All citizens 65 and over are eligible for Medicare, but unless you are already receiving Social Security, you must enroll in the program beginning 3 months before you turn 65. If you don’t enroll within 7 months of turning 65, you could face penalties.  Increasingly, Medicare relies on private insurers to help cover the ever-rising costs of health care. But participating comes at a cost of tighter government regulation and strict rules that many private companies turn away from. If your plan decides to leave the Medicare program, you will have to find another one.  

One of the major benefits of Medicare is that it offers affordable health coverage for older people who might not be able to afford it otherwise. However, Medicare comes with the trade-off of more restrictions and rules, limiting the providers you can see and the benefits you may receive.  If you receive health insurance from your employer, you may lose benefits if you enroll in a Medicare Advantage plan. As with all health insurance issues, knowing can save you a lot of money in the long run.  Deciding which Medicare plan to enroll in can be a bewildering decision. Fortunately, EINSURANCE knows how the complexities of health insurance affect people like you.

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