Medicare

Medicare 101

What Is Medicare?

  • A federal health insurance program
  • Run by the Centers for Medicare and Medicaid Services (CMS)
  • Benefit decisions controlled by the U.S Congress
  • Social Security Administration (SSA) handles enrollment and eligibility

Who is Eligible For Medicare?

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Hospital Insurance (known as Medicare Part A)

What is Hospital Insurance (Part A)?

Part A is hospital insurance that helps cover inpatient care in hospitals, skilled nursing facility, hospice, and home health care.

What is Covered?

  • Hospital stays
    • Semi-private room, meals, nursing, supplies, medication

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Medical Insurance (known as Medicare Part B)

What is Part B?

Part B helps cover medically necessary services like doctors' services, outpatient care, durable medical equipment, home health services, and other medical services. Part B also covers some preventive services.

In General, Part B Covers:

  • Clinical research
  • Ambulance services

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Medicare Advantage Plan (known as Medicare Part C)

What is a Medicare Advantage Plan (Part C)?

A Medicare Advantage Plan (like an HMO or PPO) is another Medicare health plan choice you may have as part of Medicare. Medicare Part C is provided through private companies that have contracts with Medicare offer Medicare Advantage Plans, sometimes called "Part C" or "MA Plans."

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Prescription Drug Coverage (also known as Medicare Part D)

What Part D Plans Cover?

  • Offered by private companies contracting with Medicare
    • Each plan has a list of drugs it covers and a list of pharmacies beneficiaries may use
  • Each plan has its own list of covered drugs (called a formulary). Many Medicare drug plans place drugs into different "tiers" on their formularies. Drugs in each tier have a different cost.

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