Overview of Medicare
This is an audio broadcast prepared by California Health Advocates entitled “Medicare: an Overview.” In this broadcast, we will briefly go over what Medicare is, the different parts of Medicare (Parts A-D), programs for people with low-income, and where to get help and more information about Medicare.
1) What is Medicare
Medicare is a Federal health insurance program. It covers most people age 65 and over, some people younger than 65 with disabilities, people diagnosed with amyotrophic lateral sclerosis (ALS) also known as Lou Gehrig’s disease, and those with end-stage renal disease (ESRD).
2) The Different Parts of Medicare
Medicare is divided into 4 parts:
- Part A – Hospital Insurance
- Part B – Medical Insurance
- Part C – Medicare Advantage
- Part D – Prescription Drug Coverage
Part A – Hospital Insurance — covers most inpatient hospital care, some inpatient skilled nursing facility care, some home health care, and hospice care.
Part B – Medical Insurance – covers a portion of outpatient medical services such as doctors’ services, out-patient hospital care, laboratory tests, out-patient physical and speech therapy, some home health care, ambulance services, and some medical equipment and supplies.
Part C – Medicare Advantage –allows you to enroll in and receive your Medicare Part A, Part B, and in cases Part D, benefits through private health insurance plans. Under Part C, Medicare contracts with Medicare Advantage plans as part of the Medicare program and pays the plans to manage beneficiaries’ health care. All MA plans must at least provide all the Medicare benefits covered under Parts A and B. Some MA plans also provide Part D prescription drug coverage and are often called MA-PD plans.
The 5 different types of MA plans include: HMOs, PPOs, Private Fee-for-Service plans. Medical Savings Accounts (MSAs), and Special Needs Plans.
Part D – Prescription Drug Coverage – Medicare provides drug coverage through private drug plans. Under Part D, there are 2 types of drug plans: 1) plans that only provide drug coverage – known as Prescription Drug Plans (or PDPs), and 2) Medicare Advantage plans that also provide prescription drug coverage (known as MA-PDs).
Note: having Medicare does not mean that all your medical services are covered. Of the services Medicare does cover, it only pays for some of your costs, not 100%.
For example, Medicare covers outpatient doctor’s visits but only pays 80% of the cost. You, as the beneficiary are responsible to pay the other 20%, depending on whether you have additional supplemental insurance. Even though Medicare pays for some preventive services and does cover most medically necessary services, the percentage of beneficiaries’ out-of-pocket health care expenses is sizable and continues to increase with age.
For an easy-to-read chart outlining Medicare’s coverage and costs (such as deductibles, co-insurance, and premiums), see the ‘Medicare Basics’ section of our website at www.cahealthadvocates.org.
There are many ways to receive your Medicare benefits. For example, you can have what’s called Original fee-for-service Medicare where you use your Medicare card and receive your care and treatment from doctors and providers who accept Medicare and at Medicare-certified facilities. With Original Medicare you can supplement your Medicare coverage with other kinds of insurance, such as retiree or employer coverage, or Medicare Supplemental insurance (also known as Medigaps).
Another option is to receive your Medicare benefits through a Medicare Advantage plan as earlier discussed.
In order to learn about all of your options, and how different kinds of insurance may or may not work with each other, you can call the Health Insurance Counseling & Advocacy Program for free, unbiased, individual counseling. We will give you their number at the end of this recording.
3) Programs for People with Low-Income
If you have low-income and assets, you may be able to get help with your Medicare healthcare costs through one of several programs. Some of these programs include: California’s Medicaid program, known as Medi-Cal; the Medicare Savings Programs; and the Part D Low-Income Subsidy (LIS).
California’s Medicaid program -Medi-Cal, pays for some care that Medicare doesn’t, such as dental care, hearing aids, adult day health care, home health care (personal, non-skilled services) and long-term care. It also helps pay the cost-sharing for things Medicare does cover (such as co-insurance, deductibles, and the Medicare Part B premium).
The Medicare Savings Programs (MSPs) also pay for some of Medicare’s cost-sharing, such as the Medicare Part B monthly premium. These programs are known as the Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB) and Qualified Individual (QI) programs.
The Part D Low-Income Subsidy (LIS) provides extra help with Medicare’s Part D prescription drug costs. Depending on your income and which Part D plan you enroll in, the LIS can cover your Part D deductible and monthly premium, and set minimal copayment amounts for your covered medications.
4) Where to get more help and information
If you would like to talk to someone to learn more about your options under Medicare and related health coverage issues, you can get free individual counseling by calling the Health Insurance Counseling & Advocacy Program (HICAP), with offices in every county in California and a toll-free hotline. HICAP is a volunteer-supported program that provides unbiased information to help Medicare beneficiaries make the best choices for their individual health care needs. The California Department of Aging administers HICAP services.
This has been an audio broadcast produced by California Health Advocates. Thanks for listening.