Medicare is a federal health insurance program in the United States that primarily serves individuals aged 65 and older, as well as some younger individuals with specific disabilities or medical conditions. It was established in 1965 and is administered by the Centers for Medicare & Medicaid Services (CMS), a division of the U.S. Department of Health and Human Services.
Medicare provides a range of healthcare services and coverage options to eligible individuals, helping to offset the costs of medical care. The program is divided into different parts, each covering specific services:
- Part A (Hospital Insurance): This covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.
- Part B (Medical Insurance): This covers outpatient care, doctor’s visits, preventive services, some home health care, and certain durable medical equipment. Beneficiaries pay a monthly premium for Part B coverage.
- Part C (Medicare Advantage): Private insurance companies approved by Medicare offer Part C plans, which provide all the benefits of Part A and Part B, and often include additional benefits such as vision, dental, and prescription drug coverage. Medicare Advantage plans may have their own costs and rules.
- Part D (Prescription Drug Coverage): This covers prescription medications. Part D plans are offered by private insurance companies and require a monthly premium.
It’s important to note that while Medicare provides significant coverage, it doesn’t cover all healthcare expenses. Beneficiaries may still have out-of-pocket costs such as deductibles, copayments, and coinsurance.
Eligibility for Medicare is generally based on age, disability status, and certain medical conditions. Enrollment typically begins three months before the individual turns 65 and continues for seven months (three months before, the month of, and three months after the 65th birthday). If someone is receiving Social Security benefits, they are usually enrolled automatically in Part A and Part B when they become eligible.
Medicare can be a complex program with various options and rules, so it’s important to carefully review the available plans and understand how they work before making enrollment decisions. Many people also choose to supplement their Medicare coverage with additional insurance, known as Medigap policies, to help cover some of the costs that Medicare doesn’t pay.
