A Complete Guide to Medicare Basics

Introduction to Medicare Essentials
Medicare provides financial support for costly healthcare services. Choosing the right Medicare plan requires understanding its fundamental components. If you're approaching 65 or qualifying for Medicare through other means, this guide offers crucial information to help you make informed decisions.

Medicare Overview and Its Components
Before selecting a plan, it’s important to grasp the basic structure of Medicare.

What Is Medicare?
Medicare is a government-funded health insurance program for individuals aged 65 and older. It is also available at a younger age under specific conditions.

Eligibility for Medicare
Individuals qualify for Medicare if they are 65 or older. Younger individuals may also be eligible if they meet certain conditions, such as:

• Diagnosed with Amyotrophic Lateral Sclerosis (ALS)
• Living with End-Stage Renal Disease requiring dialysis or transplantation
• Receiving disability benefits from Social Security or Railroad Retirement Board

Medicare Plan Components

• Medicare consists of four parts: A, B, C, and D.
• Each part covers different services, with Part C functioning as an alternative plan.

Coverage of Medicare Part A

• Part A provides hospital insurance covering inpatient care costs.
• If hospitalized, Part A covers the first 60 days with applicable deductibles.
• Beyond 60 days, costs increase, and you pay more out-of-pocket.
• Part A may also cover skilled nursing facilities and hospice care in certain cases.

What’s Included in Part B

• Part B offers outpatient medical coverage, such as doctor visits, diagnostic tests, and durable medical equipment like wheelchairs or prosthetics.
• Typically, it covers about 80% of eligible expenses, with the beneficiary paying the remaining 20%.
• A monthly premium is required, varying based on income levels.

Understanding Part C

• Part C, also known as Medicare Advantage, is an alternative way to receive Medicare benefits.
• These plans often include additional benefits and may combine Part D prescription drug coverage.

Part D Prescription Drug Coverage

• Part D provides coverage for prescription medications.
• This coverage helps reduce costs for essential medicines and is offered through private insurers contracted with Medicare.
• Premiums vary by plan, and you can compare options using Medicare’s plan finder tool.

Medicare Cost Overview

• Part A is usually free for enrollees, though hospitalization may involve deductibles.
• Part B and Part D generally require monthly premiums.

2018 Medicare Premiums and Deductibles

• In 2018, the Part A deductible was $1340.
• Part B premium in 2018 was $134 for low-income individuals, higher for others.
• The average Part D plan cost was around $34 per month.
• Private Medicare plans still require Part B premiums alongside additional coverage costs.

Medicare Advantage vs. Medigap

• Medicare Advantage plans may offer extra benefits beyond Original Medicare, sometimes including Part D drug coverage.
• Medigap plans supplement Original Medicare by covering out-of-pocket costs like deductibles, acting as a financial cushion.

We hope this overview clarifies the essentials of Medicare and helps you choose the best coverage option.