What Is Medicare?

By Victoria Simpson on March 22 2020 in Answer

Original Medicare allows you to choose any doctor or healthcare facility you prefer to use. Photo by National Cancer Institute on Unsplash
Original Medicare allows you to choose any doctor or healthcare facility you prefer to use. Photo by National Cancer Institute on Unsplash
  • Medicare is for people 65 and older and for certain young people with disabilities.
  • Medicare is offered to End-Stage Renal Disease (ESRD) patients. This is permanent kidney failure that requires dialysis or a transplant.
  • The amount you pay monthly for Medicare depends on your income.

Elderly patients and those who are not able to work may worry from time to time about being unable to pay all medical expenses. 

If you have not already been schooled in the details of Medicare, it could be good to know what it offers. Even if you may not be eligible for it, you may know someone who is and who can benefit from your knowledge. 

Medicare is a health insurance program managed by the federal government. It is offered to people who are 65 and over, qualifying young people with disabilities, and those living with End-Stage Renal Disease (ESRD). This is permanent kidney failure that requires dialysis or a transplant. 

Premiums

Your income determines how much you pay for medicare. Photo by Sharon McCutcheon on Unsplash

The amount you pay monthly for your Medicare depends on your income. The more money you earn, the more you pay. The lower your income, the lower your monthly premium. 

According to AARP.org, in 2018 if your modified adjusted gross income, (MAGI), was less than or equal to $87,000 a year for an individual, or $174,000 for a married couple filing taxes jointly, your monthly Medicare premium in 2020 would be $144.60 per month. Not bad. 

If your MAGI was over $500,000 for an individual or $750,000 for a couple in that same timeframe, that premium would go up to a maximum of $491.60 per month.  

You can have Medicare coverage in addition to other coverage you may have from your workplace, or you may use it on its own. There are various plans to choose from depending on your needs, and they all offer something slightly different. 

Plans

Original Medicare allows you to choose any doctor or healthcare facility you prefer to use. The doctor or facility needs to be enrolled in Medicare and accepting new Medicare patients. This plan generally does not cover prescription drugs but it does cover many other common needs like doctor’s visits, and you do not need to file medical claims. 

Generally speaking, there is a cost for each service you use. 

With an Original Medicare plan, you pay a set amount, (a deductible), and a portion for services and supplies, (coinsurance/ copayment). Medicare also pays its share.

It is important to note that there is no limit to what you may pay out-of-pocket with an Original Medicare plan, so if you foresee that you may have large medical bills in your life, you may wish to examine the benefits of another Medicare plan, Medicare Advantage.

A Medicare Advantage plan does have a limit to what you will be asked to pay out-of-pocket throughout the year. Once you reach your limit, Medicare will cover everything for the remainder of the year. (Hopefully, you fall sick at the right time, should you ever).

If your stars are aligned right, this plan could be more cost-effective for you as a patient than the original plan. 

Medicare also offers Americans Medicare Part A (Hospital Insurance), which covers stays in hospitals, care in a skilled nursing facility, some home health care, and hospice care. 

Medicare Part B (Medical Insurance) covers some doctors' services, outpatient care, medical supplies, and preventive services. 

Medicare Part C is essentially Medicare Advantage, (confusing, but a fact), and this is marketed as an “all in one” alternative to Original Medicare.

There are also Medicare Prescription Drug Plans, Medicare Medical Savings Account Plans, Medicare Private-Fee-for-Service Plans and Retiree Insurance Plans: you name it, the feds may have you covered.

Does it all sound attractive? Visit Medicare’s website to answer your questions and sign up. 

More in Answer