Medicare – All you need to know

Medicare can be defined as a federally assisted health insurance program that allows adults over the age of 65, individuals less than 65 but with certain disabilities, and those with End-Stage Renal diseases (ESRD) to enroll in the program. The program is funded by social security and also with the taxes that you pay from your income.

How to get Medicare benefits?

To be very specific, there are two ways through which you can get health care benefits. The Orignal Medicare is provided directly through the federal government and the medicare advantage plan. The original Medicare is regarded as a traditional way of getting Medicare, while the medicare advantage plan is more specified to the companies that offer private insurance.

Original Medicare

If you have original Medicare, the government pays for your health services directly. The original program is subdivided into two parts, part A and part B. Part A covers the necessary hospital inpatient care, hospice care, home health care, and skilled nursing facility (SNF).
Part B is more focused on medical insurance. It covers the fees such as preventive care and doctors’ services, Durable Medical Equipment (DME), hospital outpatient care, mental health services, laboratory tests, X-rays, ambulance services, and some home health care services.
When you enroll yourself in this program, it tells:

  • You will be receiving a white, red, and blue card that you will be showing to the healthcare providers.
  • Most of the health care providers take your insurance
  • You may participate in the cost-sharing of original Medicare (a price that you have to pay yourself for co-insurance, deductibles, and premiums.
  • You are qualified to enroll for Medigap, which is regarded as a health insurance policy that assists in getting benefits and reduces the out of pocket costs. Out-of-pocket costs are the amount of money that you have to pay yourself because the Medicare or health insurance you have chosen does not cover that amount.
  • If you have enrolled in the program, you can get a check-up through a specialist without any prior authorization.
  • The program puts limitations on the charges according to the providers (non-participating and participating), but there is no limitation on the charge for the providers who opt out of the program.

There may come a time when you decide to change your coverage plans from the original Medicare to the medicare advantage plan. In such cases, you should be aware of the enrollment periods. After covering these periods, you are allowed to change your coverage plans.
You may ask what benefits original Medicare does not cover. The answer is that original Medicare benefits prescription drugs. Prescription drugs can be explained as those drugs that cannot be bought without the prescription of a provider. Prescription drug benefit (Part D) is usually offered by private companies. To get such a benefit, you can apply for the advantage plan or the part d prescription drug benefit.

Advantage Plan

Photo by Rod Long on Unsplash

Most people indeed get their health coverage through Original Medicare. But there are still some individuals who choose private companies to provide them with health insurance. This coverage is also called part C or medicare private health plan. The private companies that offer such health insurance are in contract with the federal government. The federal government provides them with a fixed proportion of money that can be used to offer healthcare benefits to the people.
It is for sure that when you apply or enroll yourself in an MA plan, you will be obtaining the similar benefits that are offered at the original Medicare. But there may be some rules and regulations that may differ from the original program.
You may ask for the reason for choosing an MA plan over the original program. The answer is quite simple; the MA plan has some additional benefits like dental and vision care, housekeeping support, training, and caregiver counseling. However, it is not important that all companies providing MA plans will be giving the same kind of additional benefits. You must confirm it before enrolling in the program.

The difference between Medicaid and Medicare?

There is a difference between the Medicaid program and the Medicare program. Medicare allows individuals above the age of 65 and adults with disabilities to enroll in the program and is not at all restricted to your income. On the other hand, Medicaid usually covers those individuals who are needy; that is, they have a low income because of which they cannot cover their medical expenses. When you are eligible for both programs and enroll yourself in both them, you will be given health care benefits at low costs through both programs. They do not contradict but can work together for the well-being of an individual.

Medicare insurance vs. private health insurance

Medicare insurance can be described as individual insurance. It is because it is more restricted to individuals. There is no extension in the coverage plan, unlike the people with private health insurance who have the option of extending the coverage for their family members such as children and spouse. In Medicare, you as an individual get the healthcare benefits when you justify the eligibility with your age and disability.

What services it doesn’t cover?

Some common expenses are not covered by Medicare, such as:

  • Dentures
  • Medical care overseas
  • Message therapy
  • Cosmetic surgery
  • Most dental care
  • Eyeglasses and eye examination

CDPAP and Medicare

There are many health care providers in the states that can assist you in getting home health care benefits through the CDPAP program. The CDPAP program can be explained as a Consumer Directed Assistance Program that allows the eligible candidates to receive home health care services through home health care agencies. The one’s enrolling in the CDPAP program are allowed to choose any of their family member, friend, or neighbor to take care of them. The caretakers are then paid by the agency because of the care they provide. You can contact Direct Personal Care to help you in the process. If you have a Medicaid or medicare license, you are eligible to join this program.

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