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Medicare Insurance

Health Insurance Program

        Medicare Insurance is a health insurance program for:

  • people age 65 or older
  • people under age 65 with certain disabilities and
  • people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant)

Types of Medicare Insurance Programs

        Medicare Insurance has the following programs:

Hospital Insurance

      Most people don't pay a premium for Hospital Insurance (Medicare Part A) because a spouse or a member of the family has already paid for it through their payroll taxes while working. Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals, including critical access hospitals and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits.

Medical Insurance

      Most people pay a monthly premium for Medical Insurance. Medicare Part B (Medical Insurance) helps cover doctors' services and outpatient care. It also covers some other medical services that Hospital Insurance (Medicare Part A) doesn't cover, such as some of the services of physical and occupational therapists and some home health care. Medical Insurance (Medicare Part B) helps pay for these covered services and supplies when they are medically necessary.

Prescription Drug Coverage

      Most people will pay a monthly premium for this coverage. Starting January 1, 2006, new Medicare Prescription Drug Coverage will be available to everyone with Medicare. Everyone with Medicare Insurance can get this coverage that may help lower prescription drug costs and help protect against higher costs in the future. Medicare Prescription Drug Coverage is insurance. Private companies provide the coverage. Beneficiaries choose the drug plan and pay a monthly premium. Like any other insurance, if a beneficiary decides not to enroll in a drug plan when they are first eligible, they may just pay a penalty if they choose to join later.

Medicare Insurance Approved Facilities

    In recent years, Medicare has issued several national coverage determinations providing coverage for services and procedures of a complex nature, with the stipulation that the facilities providing these services meet certain criteria. These criteria usually require, in part, that the facilities meet the minimum standards to ensure the safety of beneficiaries receiving these services in order to be considered as a provider with the ability and expertise to perform the procedure. Being certified as a Medicare approved facility is required for performing the following procedures: lung volume reduction surgery, carotid artery stenting, VAD destination therapy, bariatric surgery, and certain oncologic PET scans in Medicare-specified studies.

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