What Medicare Covers: Health Coverage For When You Retire

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Health insurance is one of the many things people must consider as they approach their retirement. Fortunately, there is a health insurance program administered by the United States government that was designed to provide coverage for individuals aged 65 and over known as Medicare. For those who are preparing to enroll for their first year of Medicare coverage, the task of choosing the right plan might seem a bit complicated. Here is a guide to help you understand what Medicare covers to help you choose the appropriate coverage plan.

What Medicare Covers

To find out what Medicare covers, you need to understand the various benefit options available. Medicare is split into four different parts, each offering coverage for specific services:

Medicare Part A: Medicare Part A covers the hospital insurance portion of your health insurance coverage. This includes inpatient hospital care, nursing facilities, hospice and home health care. In most cases, Part A premium fees are waived, as long as the individual paid Medicare taxes while working.

Medicare Part B: Medicare Part B covers any medical services deemed necessary, like visits to your doctor, outpatient care and various medical services. Part B coverage also includes preventative care to prevent or detect specific illnesses, like the flu.

Medicare Part C: Medicare Part C is also referred to as the Medicare Advantage Plan. The Medicare Advantage Plan functions like an HMO or PPO insurance plan, where coverage is provided by private health insurance companies that have been approved by Medicare. Some examples of Medicare Part C providers are Aetna Medicare, Kaiser Medicare and Humana Medicare. Medicare Part C includes the same coverage for both Part A and Part B plans for Medicare. However, Medicare Advantage Plans also offer additional coverage that can include dental, vision, hearing, and health and wellness programs. Many Part C coverage plans also include Medicare prescription drug coverage, which is the Part D portion of Medicare.

Medicare Part D: Medicare Part D covers prescription drugs for those enrolled in Medicare. This option helps cover the cost of prescription drugs, may help lower what you pay for prescription drugs, and can protect you against rising costs of prescription drugs in the future. To receive the benefits of Medicare Part D, you must join a prescription drug plan from an insurance company or other private company that has been approved by Medicare.

Medicare Eligibility

Before you can enroll for Medicare health coverage, you must meet certain eligibility requirements. Here is a quick guideline to help you determine whether or not you are eligible for Medicare:

  • You are age 65 or older.
  • You or your spouse worked a minimum of 10 years in Medicare-covered employment.
  • You are a citizen or permanent resident of the United States.
  • You are eligible for Social Security or Railroad benefits or are already receiving them.

If you don't fall within the specific guidelines above, it is still possible to enroll for Medicare if you meet one of the following criteria:

  • Are under 65 with certain disabilities
  • A person of any age who is suffering from end-Stage Renal Disease

If you are unsure about your eligibility for Medicare, you can visit Medicare.gov or call Social Security at 1-800-772-1213, or you can visit or call your local Social Security office.

Medicare Plans

There are two main Medicare plans that most people enroll in: Original Medicare and Medicare Advantage Plan.

Original Medicare: When enrolling for this plan, you must determine whether you wish to enroll in Part A, Part B or both. You will also need to determine if you want to enroll in Medicare Part D for prescription medication. Your final option is to enroll in Medigap, which is supplemental coverage that will fill any gaps in Original Medicare coverage. This coverage is directly provided by Medicare, and most people only need to pay a monthly premium for Part B coverage, since Part A fees are typically waived for those who have paid Medicare taxes while working.

Medicare Advantage Plan (Part C): Like it was mentioned earlier, this is a combination of Medicare Part A and Part B, with some insurance companies offering options for Part D. Like other PPO or HMO plans, you must use doctors, hospitals and health providers that are within the plan, or you end up paying most or all of the costs. You must also pay a monthly premium on top of your Part B premium along with copayments or coinsurance for certain services.

At a glance, Original Medicare might seem more appealing than a Medicare Advantage Plan due to lower costs and fees. However, keep in mind that Medicare Advantage Plans also come with additional benefits like dental, vision and hearing, which many people might be interested in. Factors like monthly premiums, deductibles, copayments and network providers will help you determine what Medicare plan is best suited for your needs.

Now that you have been familiarized with what Medicare covers, visit Medicare.gov for further information on enrollment, understanding claims, savings programs and other frequently asked questions regarding Medicare.

Last Updated: October 8, 2011
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About Matthew Cenzon Matthew Cenzon has been writing for numerous publications since 2003, covering topics ranging from health and nutrition to the real estate industry. He is one of the contributing writers for CanDoFinance.com, and is a college graduate of the University of California, Riverside, with degrees in English and Asian literature. Matthew's interest and knowledge in finance stem from over five years spent working in residential real estate appraisal. 

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