Understanding Medicare

What’s Medicare? 

Medicare is health insurance for people 65 or older, people under 65 with certain disabilities, and people of any age with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant).

Medicare Part A (Hospital Insurance) helps cover: 

• Inpatient care in hospitals 

• Skilled nursing facility care 

• Hospice care 

• Home health care 

Medicare Part B (Medical Insurance) helps cover: 

• Services from doctors and other health care providers 

• Outpatient care 

• Home health care 

• Durable medical equipment 

• Some preventive services 

Medicare Part C (Medicare Advantage Plans) 

• Includes all benefits and services covered under Part A and Part B 

• Usually includes Medicare prescription drug coverage (Part D) as part of the plan 

• Run by Medicare-approved private insurance companies 

• May include extra benefits and services for an extra cost 

Medicare Part D (Prescription Drug Coverage) 

• Helps cover the cost of prescription drugs

• Run by Medicare-approved private insurance companies

• May help lower your prescription drug costs and help protect against higher costs in the future

Other Medicare health plans

 Some types of Medicare health plans that provide health care coverage aren’t Medicare Advantage Plans but are still part of Medicare. Some of these plans provide Part A and/or Part B coverage, and some also provide Medicare prescription drug coverage. These plans have some of the same rules as Medicare Advantage Plans. Some examples include Medicare Cost Plans, Demonstration or Pilot Programs, and Programs of All-inclusive Care for the Elderly (PACE). 

Medicare Health Benefit

The Medicare Health Benefit covers the following individuals:

• Age 65 or older 

• Younger than 65 with a disability 

• With end-stage renal disease (any age)

The Medicare home health benefit pays for homecare services under Part A and B. Beneficiaries do not have to have both Part A and B to receive homecare services.

Medicare Advantage plans

Medicare also contracts with a private company to offer patients their Part A and Part B benefits. Medicare Advantage Plans include HMOs, PPOs, private fee-for-service plans, special needs plans, and Medicare medical savings account plans. Services are paid for by the private company and not under Original Medicare.

Medicare Part A

Medicare Part A helps cover hospital inpatient care, skilled nursing facilities, hospice care, and home health care. Beneficiaries must meet certain required conditions to qualify for these benefits. Individuals and their spouses who paid the Medicare tax while working do not pay a monthly premium for the Medicare Part A benefit. Most people meet the requirement for a premium-free Part A; however, if they don’t meet the requirements for a premium-free Part A, it is available for a monthly fee.

Medicare Part A covers eligible home health services such as intermittent skilled nursing care, physical therapy, speech-language pathology services, continued occupational services, social services, home health aide services, and medical supplies used in the home. 

Medicare doesn’t pay for the following:

 • 24-hour-a-day care at home 

 • Meals delivered to the home  

 • Homemaker services 

 • Personal care 

Medicare Part B

Most people pay a monthly premium for Medicare Part B. Medicare Part B helps cover doctors’ services, outpatient care, outpatient therapy services, and limited home health care. Medicare Part B helps pay for these covered services and supplies when they are deemed to be medically necessary.