Medicare is a federal health insurance program under the Centers for Medicare and Medicaid Services (CMS). It is primarily designed for people aged 65 and older, but it also covers certain younger people with disabilities and individuals with End-Stage Renal Disease (ESRD). Once an individual becomes eligible, they can enroll either in Original Medicare or Medicare Advantage.
Medicare is divided into four main parts, each serving a distinct purpose in providing comprehensive health coverage:
Medicare Part A is hospital insurance. It covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. This part helps manage the costs associated with more intensive medical services that require hospitalization.
Medicare Part B is medical insurance / fee-for-service. It covers certain doctors’ services, outpatient care, medical supplies, and preventive services. Part B focuses on the medical costs outside of the hospital, such as regular doctor visits, blood tests, and X-rays.
Medicare Part C, also known as Medicare Advantage, is an alternative to Original Medicare (Part A and Part B). Offered by private insurance companies approved by Medicare, it includes all the benefits and services covered under Part A and Part B, and often includes Medicare prescription drug coverage (Part D) as part of the plan. Medicare Advantage plans may also offer extra benefits, such as vision, hearing, and dental coverage.
Medicare Part D is prescription drug coverage. It helps cover the cost of prescription drugs, including many recommended shots or vaccines. Part D plans are run by Medicare-approved private insurance companies.
Medicare plays a pivotal role in the healthcare system for older adults and people with certain disabilities, ensuring access to necessary medical services that might otherwise be financially out of reach. The importance of Medicare in healthcare can be summarized through its contribution to the wellbeing and financial stability of its beneficiaries (around 60 million patients).