What is Medicare?

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About Medicare Medicare Parts

Medicare Can Be Confusing

That’s why we’re here. We specialize in the Medicare-eligible market, and our Licensed insurance agents will help you understand which health plan is best for your needs.

If you are a legal resident in the United States and are over the age 65, or under age 65 with certain disabilities or qualifying conditions you may be eligible for Medicare. Medicare is a federal health insurance program that provides medical benefits to specific groups, such as people age 65 or older and younger people with disabilities, and people with End-Stage Renal Disease (ESRD) or ALS.

Though the name is similar, it should not be confused with Medicaid, a joint federal and state health coverage program available to low-income individuals. It may seem difficult at first to tell these two programs apart. However, one key difference should be noted. While the requirements to be eligible for Medicaid are strictly defined, Medicare is federal health insurance generally for people 65 or older or certain people with qualifying disabilities, End-Stage Renal Disease (ESRD), or ALS.

Common Medicare Questions

What is Medicare?

Medicare is a federal health insurance program legal residents of the United States, who are 65 years of age or older, and certain people under 65 with specific disabilities or End-Stage Renal Disease (ESRD) or ALS. Eligibility for Medicare is not related to income; instead, it is primarily determined by age, disability status, or certain qualifying medical conditions, and eligibility for premium-free Part A may depend on work history and payroll taxes paid. Medicare is a federally administered health insurance program, so there is less variation between states than with Medicaid, which is administered jointly by federal and state governments.

Medicare coverage functions similarly to many private healthcare insurance options. It will pay a portion of the beneficiary’s medical cost while expecting a deductible, coinsurance, co-pay and premiums from the beneficiary. Unlike private healthcare insurance options, however, a person and their spouse will have to enroll separately as Medicare can only provide for one person at a time.

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Who Administers Medicare?

Medicare’s different parts are administered in different ways.

When enrolled in Part A and Part B, this is known as Traditional or Original Medicare. The federal government administers this program through Medicare.

Part C is known as a Medicare Advantage Plan. It provides both Part A, Part B benefits, and often includes Part D prescription drug coverage, though not all plans do. Part C is offered by private insurance companies approved by Medicare and regulated by the federal government.

Part D provides Medicare prescription drug coverage. This coverage is optional but is available to everyone who has traditional Medicare coverage. Some Part C plans include prescription drug coverage, which means you do not need to enroll in a separate Part D plan. Keep in mind, though, that some Part C plans do not include prescription drug coverage. Private insurance companies administer separate Part D plans.

Who is Eligible for Medicare?

Medicare is generally available to U.S. citizens and legal permanent residents (who have lived in the U.S. continuously for at least five years) beginning the month they turn 65. Citizenship alone is not sufficient; legal residency requirements also apply. For those receiving Social Security Disability Insurance or Railroad Retirement disability benefits, Medicare is available after 24 months of receiving those benefits, except for those with ALS. They become eligible the first month they receive Social Security disability benefits. Those with End Stage Renal Disease will become eligible for Medicare on the first day of the fourth month of receiving renal dialysis treatments. although earlier coverage may apply in some situations, such as home dialysis training.

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Medicare Is Split Into Four Parts:

Part A

Covers inpatient hospital services, in skilled nursing facility care (following a qualifying hospital stay), some home healthcare, and hospice care.

Part B

Covers outpatient care, including doctor and other provider services, some home health care, ambulance services, therapeutic/rehabilitation services, mental health services, durable medical equipment like oxygen equipment and wheelchairs, and certain prescription drugs that a physician typically administers.

Part C

An alternative way to receive your Medicare covered benefits. It is also called Medicare Advantage. These plans are offered by private insurance companies approved by Medicare and provide all Part A (hospital) and Part B (medical) services, many plans often including prescription drug coverage (Part D) and may offer additional plan benefits not covered by Original Medicare.

Part D

Offered through private insurance companies approved by Medicare and helps beneficiaries pay for the cost of covered prescription medications. Covers outpatient prescription drugs that you would typically pick up at a pharmacy.

A hassle-free way to learn about Medicare benefits?

Imagine that.

We go above and beyond to help you find the plan that works best for your needs because it’s what you deserve. Get your free, no-obligation quote to see how Elite Insurance Group can help you get the most out of your Medicare benefits.

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