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Medicare 101: Understanding the basics

by Barbara Etienne

Created on: August 30, 2008   Last Updated: October 11, 2008

The "baby boomer" population of the United States continues to age and the number of people leaving the workforce for retirement continues to grow. In addition, many employers have discontinued offering health care benefits to their retirees. Millions of people are wondering how they will manage health care costs. Medicare is here to help.

Medicare is a health insurance program for people over 65, those who are under 65 with qualifying disabilities, and people of any age with End-Stage Renal Disease. Medicare is administered by the Centers for Medicare and Medicaid Services (CMS), which is a part of the U.S. Department of Health and Social Services. It covers costs for many preventative health services such as cardiovascular and cancer screenings. Early diagnosis and treatment increases the likelihood for a positive outcome.

Various types of Medicare plans are available. Enrollees in the Original Medicare Plan (Parts A and B) are usually charged fees for health care services and supplies. This is also known as a "fee-for-service" plan. Part A is a hospital insurance program administered by the Federal government. Premiums are usually paid from payroll taxes from the beneficiary or their spouse prior to retirement. It assists with payment for inpatient stays, skilled nursing facilities, hospice, and some types of home health care. Medicare Part B helps cover outpatient care and doctor's services.

Medicare Advantage Plans (Part C) are health plans much like PPOs and HMOs) that are approved by Medicare but administered by private companies. Some of these plans charge additional premiums. Beneficiaries may be required to see doctors who belong to the plan or go to specific facilities to receive covered services. These plans may also provide benefits not provided by Parts A and B.

Prescription drug coverage (Part D) is offered to everyone enrolled in Medicare. This plan is also approved by Medicare and administered by private companies. Part D can help to lower patient prescription costs today and may also help to guard against higher prescription rates in the future.

One of the many types of Medicare Supplement policies is the Medigap policy, which helps to "bridge the gap" between what the Original Medicare Plan does and does not cover. It can assist with payment for some health care services and expenses as well as pay deductibles, coinsurance, and copayments. It is important to note that each policy will cover only one person.

Medicare recipients have guaranteed protections

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