Medicare 101

Medicare is the Federal health insurance program for individuals who are aged (65 and over) and younger individuals who have certain health conditions or are disabled. Medicare eligibility does not take into consideration an individuals income. However, individuals may pay higher premiums based on income, and low-income individuals may be eligible for additional assistance.

Individuals can receive their Medicare medical coverage:

• Directly from the federal government, which pays for services on a fee-for-service basis (this program is known as “original medicare” or “fee-for service medicare.” 
• Or through a private health plan.

Individuals must receive their Medicare Part D outpatient drug benefits through a private health plan (even if they get their medical coverage through original medicare).

Parts A, B, C, and D

Part A is referred to as “hosptial insurance benefits.” Part A also covers other inpatient care, including skilled nursing facilities, rehabilation facilities, and hospice.

Part B is referred to as “Supplementary Medical Insurance Benefits. “ Part B covers a broad range of outpatient services such as physician care,and drugs that are administered by physicians or other health care professionals (such as certain vaccines and intravenous medications.)

Part C regulates and authorizes Medicare Advantage plans, which must cover Part A (except for hospice) and Part B benefits. Individuals enrolled in a Part C plan still get hospice benefits, but they are paid for by Original Medicare.

Part D covers prescription drug benefits (for self-administered drugs, such as those picked up at a pharmacy and taken at home.) and regulates Medicare prescription drug plans.