Medicare is a social health insurance programme run by the Federal Government to help aid the medical expenses of senior citizens of the USA (65 and above). Speaking of those below 65 years of age, individuals with enduring disabilities and renal failure that require dialysis, etc. can enroll for Medicare too.
Medicare coverage mainly depends upon the Part of Medicare that one enrolls in. Three months prior to one's 65th birthday, one receives a Medicare card, which proves that one has Medicare health insurance. Upon turning 65, one automatically becomes eligible for Medicare. Nevertheless, s/he has to enroll for Medicare in the open enrollment period that is from November 15th to December 31st. On enrolling for Medicare, one receives direct access to Medicare Part A (Hospital Insurance) that is free of cost, which means no premiums to be paid. Anyone who is eligible for Part A automatically becomes eligible for Part B (Medical Insurance) too. However, if s/he already receives social security, then Medicare Part B may not be required; it can be opted out of by following instructions on the Medicare card.
Medicare has four categories, if one owns one or a combination of these, s/he would get the following coverage for each Part.
Since Part A is known as Hospital Insurance, it covers all in-patient hospital expenses. These include hospice care and interval term in hospice care, blood transfusion (barring three pints annually), home health care but not adult supervision, long-term hospital care but up to 60 days of hospitalization, after 60 days the coverage lessens, on crossing 150 days, the coverage stops. It also covers obesity bariatric surgeries, expenses incurred by the beneficiary on visiting non-medical health care institutions that work on religious grounds, skilled but not private nursing facilities, room services in hospitals excluding TV and VCR in rooms, medical equipment and other such supplies, etc, social services, chemotherapy, prescription drugs, anesthesia, conveyance, regular meals, laboratory tests and the like.
Next is Part B or Medical Insurance. If one chooses to keep this Part then s/he will get coverage on medical expenses and most things that Part A fails to cover. Part B covers 80% of the medical bill and the remaining 20% is to be borne by the beneficiary. This 20% is the co-insurance or the co-pay that the beneficiary pays, and of course, there are deductibles too. The medical expenses falling under Part B are outpatient doctor's/physician's services, medical and surgical services, glaucoma tests, ambulance conveyance, mental illness, prosthesis, bone mass density measurement, radiation treatments, breast cancer and other cancer screenings, diagnostic tests, cardiovascular tests. It also covers mammograms, emergency room treatment, radiology and pathology treatment. Unlike Part A, Part B requires individuals to pay premiums. The residual 20%, that the beneficiary has to pay could turn out to be an amount that may be far from affordable at times. Hence, there is an option known as Medigap. Medigap plans are Medicare Supplement Plans that are sold by private insurance companies. These help pay for the expenses that Medicare does not pay for. There are 12 supplement plans that provide different types of coverage and charge different premiums too.
If a person wishes to enroll for Medicare Part C, s/he must be eligible for both Part A and B. However, Part C plans are more like a combination of Part A and Part B. These are also known as Medicare Advantage Plans, sold by Medicare approved private insurance companies. There are a number of Advantage Plans to choose from, so many that it may confuse the buyer. These plans offer additional benefits at lesser costs as compared to Medicare. Also known as managed care, they include Medicare Health Management Organizations (HMO), Medicare Private Fee For Service (PFFS), Medicare Medical Savings Account (MSA) and Medicare Special Needs, and Medicare Preferred Provider Organizations (PPO).
Part D plans i.e. prescription drug plans allow the beneficiary to claim a section of the cost of prescription drugs' cost, to be paid by Medicare. Anyone who is eligible for Parts A, B and C becomes eligible for Part D, not considering his/her health history and amount of income earned.
This is what all Medicare covers for its beneficiaries. For all those expenses ignored by Medicare, Medigap and Medicare Supplement Plans come to the rescue.
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