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 live in the United States and are over the age 65 or permanently disabled, you may be eligible for Medicare coverage. Medicare is a federal health insurance program that provides medical benefits to specific groups, such as people 65 or older and those with disabilities.

Though the name is similar, it should not be confused with Medicaid, a health coverage program available to low-income individuals and families. 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 health insurance for people 65 or older or people with disabilities, End-Stage Renal Disease (ESRD), or ALS.

Common Medicare Questions

What is Medicare?

Medicare provides a federal health care insurance program to residents of the United States, who are 65 years of age or older, and people with specific disabilities or End-Stage Renal Disease (ESRD). Eligibility is not related to income; instead, it is primarily determined by age, disability status, or qualifying medical conditions, and eligibility may depend on work history and payroll taxes paid. The federal government oversees the Medicare program, so there is less variation between states than with Medicaid.

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, and co-pay 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?

The four parts of the program are administered slightly differently. You enroll in each one separately – or bundle them through Part C.

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

Part C is known as a Medicare Advantage Plan. It bundles Part A, Part B, and Part D services. Part C is administered by government-approved private insurance companies 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 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. 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 or Railroad Retirement disability benefits, Medicare is available after 24 months of receiving those benefits, except for those with ALS. They become eligible as soon as they receive Social Security disability benefits. Those with End Stage Renal Disease will become eligible on the first day of the third month of receiving renal dialysis treatments.

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Medicare Is Split Into Four Parts:

Part A

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

Part B

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

Part C

An alternative way to receive your Medicare 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) coverage, often including additional benefits such as prescription drug coverage, dental, vision, and wellness programs.

Part D

Offered through private insurance companies approved by Medicare and helps beneficiaries pay for the cost of 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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