Medicare 101

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Medicare is the federal government program that provides health care coverage if you are 65+, under 65 and receiving Social Security Disability Insurance for a certain amount of time, or under 65 and with End-Stage Renal Disease.


Once you have become Medicare-eligible and enroll, you can choose to get your Medicare benefits from Original Medicare, or from a Medicare Advantage Plan, a type of private insurance offered by companies that contract with Medicare (the federal government).


What is the original Medicare?


Original Medicare consists of Part A and Part B. If you have Original Medicare, the government pays directly for the health care services you receive. Additionally, enrolling in Original Medicare means:


  • You will receive a red, white, and blue Medicare card to show to your providers

  • Most doctors in the country take your insurance

  • Medicare limits how much you can be charged if you visit participating and non-participating providers, but it does not limit how much you can be charged if you visit providers who opt out of Medicare

  • You can see a specialist without prior authorization

  • You are responsible for Original Medicare cost-sharing, which may include premiums, deductibles, and coinsurances

  • You are eligible to enroll in a Medigap policy, which can help reduce your out-of-pocket costs


Part A


In general, Part A covers:

  • Inpatient care in a hospital

  • Skilled nursing facility care

  • Nursing home care (inpatient care in a skilled nursing facility that’s not custodial or long-term care)

  • Hospice care

  • Home health care


Part B


Part B covers 2 types of services Medically necessary services:


  • Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.

  • Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.


Source: https://www.medicare.gov/


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EPIA inc. is a private Insurance Agency with no ties with legal entities. The information contained in this article is based on information provided by the Medicare Official Website.

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