How Does Medicare Work?

Medicare is the federal health insurance program that makes care more accessible and affordable for: 

– People aged 65 and above

– Younger people with certain disabilities 

– People suffering from ALS or end-stage renal disease

When you enroll, you’ll have to decide between:

Original Medicare

Medicare Part A: Hospital Insurance that covers inpatient hospital stays, hospice care, and some home health care, plus care in a skilled nursing facility.

Medicare Part B: Medical Insurance that covers doctors’ services, medical supplies, outpatient care, and preventive services, for which you pay a monthly premium.

Coverage under Original Medicare is managed by the government. You do not need to choose a primary care doctor, and you don’t need a referral to see a specialist. In most cases, you can get care from any doctor, hospital, or health care facility that is enrolled in Medicare. However, there isn’t a yearly limit on out-of-pocket costs.

If you don’t already have employer or union coverage that pays costs that Original Medicare doesn’t, you may have to buy a Medicare Supplement Insurance (Medigap) policy. Most prescriptions aren’t covered in Original Medicare. You’ll have to get Part D to add drug coverage.

Medicare Advantage

Also called Part C, these plans are offered by (Medicare-approved) private companies, and are another way to get Original Medicare coverage.

These “all in one” plans include Medicare Part A and Part B, and usually Part D. They also offer coverage for vision, hearing, dental, and fitness services that Original Medicare doesn’t cover. In most cases, you’ll need to use health care providers within the plan’s network and service area. There’s a limit on annual out-of-pocket costs.

Medicare Prescription Drug Coverage 

Part D of Medicare helps pay for prescription medications, including recommended shots or vaccines.

Medicare-approved plans that offer drug coverage can vary in cost and drugs covered (e.g. generic and brand-name). How much you pay for each drug depends on the plan you choose and its formulary.