Medicare
Meaning of Medicare: Age is the usual route in, but disability, kidney failure and ALS also qualify, and the parts cover different kinds of care.
Definition of Medicare
Medicare is the federal health insurance program of the United States. It covers people from age sixty five, and younger people who qualify through a long-term disability, end-stage kidney failure or amyotrophic lateral sclerosis. Coverage is divided into parts that pay for hospital care, outpatient care and prescription drugs, and enrollees still meet premiums, deductibles and copayments.
What do the parts cover?
| Part | What it pays for |
|---|---|
| Part A | Inpatient hospital stays, skilled nursing facility care after a hospital stay, home health and hospice |
| Part B | Doctor visits, outpatient care, tests, preventive services and durable medical equipment |
| Part C | Medicare Advantage: a private plan that delivers Part A and Part B benefits, usually with drug coverage included |
| Part D | Outpatient prescription drug coverage, sold by private plans |
Parts A and B together are called Original Medicare. Part A is premium-free for most people because it was paid for through payroll taxes during working life, while Part B carries a monthly premium. The hospice benefit under Part A includes short periods of respite care so that a family caregiver can rest.
How do people fill the gaps?
Original Medicare pays a share of the bill and leaves deductibles, coinsurance and services it does not cover, notably routine dental, vision and hearing care and long-term custodial care. Two routes address that, and they are alternatives rather than layers. A Medigap policy is private supplemental insurance that pays some of what Original Medicare leaves, and it works only alongside Original Medicare. A Medicare Advantage plan instead replaces the way Original Medicare delivers those benefits, adding its own network rules and out-of-pocket maximum. A Medigap policy cannot be used with a Medicare Advantage plan, which is a common misunderstanding.
How is it different from Medicaid?
The two are separate programs that are easily confused because the names rhyme. Medicare is federal, national in its rules, and entered mainly through age or disability rather than income. Medicaid is funded jointly with the states, run state by state, and entered through low income and limited resources. Some people qualify for both and are described as dually eligible, in which case Medicaid often covers Medicare premiums and cost sharing along with services Medicare omits, particularly nursing home care. Enrollment in Medicare does not depend on income, though higher earners pay larger premiums for outpatient coverage and for their prescription plan.
Used in a sentence
The hospital verified the patient's Medicare coverage prior to scheduling the elective procedure.
Good to know
Medicare eligibility based on age is distinct from eligibility based on disability, and the parts of the program a person is enrolled in determine which services and costs are covered.