Medicare benefits are health care benefits administered by the U.S. Department of Health and Human Services. Benefits are granted to U.S. citizens who are 65 years of age or older. Spouses of beneficiaries, people who are disabled, and patients of all ages with kidney failure can also be eligible for benefits from Medicare.
There are a number of different Medicare benefits that patients can choose from. Original Medicare is a program that requires enrollees to pay a set amount for care. This set amount is considered a deductible, and once this deductible is met Medicare will pick up its share of the bill. Copays or coinsurance must also be paid for certain services, but the costs can be offset by enrolling in a Medigap plan, which is basically a supplemental health coverage plan that helps pay for things that original Medicare does not cover.
People who are enrolled in the original Medicare are given a red, white, and blue medical card to show proof of coverage. The hospital coverage in Medicare is referred to as Medicare Part A. Medical coverage is known as Medicare Part B, and this covers such things as regular doctor office visits and appointments with specialists.
Another type of benefit that Medicare enrollees can choose is a Medicare Advantage Plan (Part C), which functions a lot like an HMO or PPO. Hospital coverage is covered under the Part A program, while medical coverage is under the Part B coverage. Prescription drug coverage is usually offered in a separate plan. These Medicare benefits are not run directly by the federal government, but instead by private companies who have created networks of hospitals, doctors, and specialists. Medigap is not necessary when a person enrolls in the Medicare Advantage Plan.
Prescription drug coverage is another Medicare benefit, which is also referred to as Medicare Part D. Private companies offer prescription drug plans which can be coupled with Original Medicare, Medicare Cost Plans, and Medicare Medical Savings Plans. These plans help enrollees get the lowest price for prescriptions, though deductibles and limits are often imposed. Research should be done to find a plan that will meet individual needs.
Under the Medicare Health Plans are various types of health care systems to consider, and these include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service Plans (PFFS), Medicare Medical Savings Account Plans (MSA), and Medicare Special Needs Plans. Each type of plan has its own benefits, depending upon the needs of the enrollee. People who are interested in a plan that includes all of the Medicare benefits in one health care plan might consider enrolling in Programs of All-Inclusive Care for the Elderly (PACE), or a Medicare Cost Plan. These plans are not part of Medicare Advantage.
Because each Medicare beneficiary is unique it is wise to do some research and contact a Medicare representative to learn about which programs work best for certain health situations. Though Medicare covers a great deal of health care expenses, there are usually gaps in coverage and limits on services covered. Those enrollees who have a low income might qualify for other programs that will help pay for health services in addition to their regular Medicare benefits, and fill in some of the gaps that Medicare will not cover.
