This guide simplifies Medicare basics, covering eligibility, parts, coverage, costs, and plan options to help you make informed healthcare decisions and select the right plan tailored to your needs.

Understanding Medicare: A Simplified Guide

Medicare offers essential financial assistance for healthcare expenses. To select the most suitable plan, it’s vital to understand its core features. If you’re nearing 65 or qualify through other criteria, this comprehensive guide provides key insights to make educated choices.

Medicare at a Glance and Its Parts

Medicare is a federally funded health program primarily for those aged 65 and older, with some younger individuals qualifying under specific conditions.

Who Qualifies for Medicare?

People aged 65 or older

Individuals with ALS or End-Stage Renal Disease

Those receiving disability benefits from Social Security or Railroad Retirement

Medicare Plan Divisions

Medicare comprises Parts A, B, C, and D.

Part C offers an alternative plan with added benefits, often including Part D coverage.

Part A: Hospital Coverage

Provides inpatient hospital insurance, covering costs for hospital stays.

Initially covers 60 days of hospitalization, with deductibles applying.

Extended stays incur higher out-of-pocket expenses.

Also covers skilled nursing facilities and hospice in some cases.

Part B: Outpatient and Medical Services

Covers outpatient services like doctor visits, labs, and medical equipment.

Usually pays about 80% of eligible costs; beneficiaries pay the rest.

Requires a monthly premium, varying with income.

Part C: Medicare Advantage Plans

An alternative way to receive Medicare benefits, often including extra perks.

May bundle Part D drug coverage and additional benefits.

Part D: Prescription Drug Coverage

Offers prescription medication coverage through private insurers.

Helps lower drug costs; premiums depend on the plan selected.

Use Medicare’s plan finder to compare options.

Cost Overview

Part A is typically free, but hospital stays may involve deductibles.

Parts B and D usually require monthly costs.

2018 Medicare Payments and Deductibles

Part A deductible was $1,340.

Part B premium in 2018 was $134 for low-income individuals, higher otherwise.

Average Part D plan cost about $34/month.

Additional private coverage incurs separate premiums.

Medicare Advantage vs. Medigap Options

Advantage plans provide extra benefits, sometimes including drug coverage.

Medigap plans help cover out-of-pocket expenses, acting as a financial safety net.

This overview aims to clarify Medicare fundamentals and assist in choosing the best coverage for your needs.