Medicare is a federally funded national health insurance program for individuals over age 65, people with end-stage renal disease requiring dialysis and certain disabled individuals as well. First rolled out in 1965, Medicare and Medicaid came to fruition after President Lyndon B. Johnson signed the Social Security Amendments of 1965 into law as part of the Great Society program.
Medicare Part A
Medicare Part A pays for basic hospitalization. Specifically, Part A, or Hospital Insurance, pays for basic benefits for inpatient care in hospitals, inpatient rehab centers and long-term care hospitals, inpatient care in a skilled nursing facility (provided the prognosis is that the condition will improve), hospice, and limited home health care.
Medicare Part B (Medical Insurance)
Medicare Part B covers doctors' fees, diagnostic procedures and lab costs and medical equipment. Part B covers medical necessary services and procedures and certain preventive services. Additionally, Part B covers ambulance services, three pints of blood per year, cardiovascular screenings, limited chiropractic services to correct a subluxation, colorectal cancer screenings, diabetes screenings and self-management training, durable medical equipment such as walkers and wheelchairs, flu shots once per year, glaucoma tests, Hepatitis B shots, HIV screening, mammograms, limited mental health care, pelvic exams and pap smears, yearly physical exams, prostate cancer screenings, smoking cessation programs. A copayment typically applies.
Medicare Part C, Medicare Advantage
Medicare Part C is a mechanism that allows individuals to access medical benefits by enrolling in a managed care program, such as a health maintenance organization (HMO) or preferred provider organization (PPO). While all Medicare Advantage programs must provide certain baseline services under Medicare Part A and Part B, Medicare Advantage providers can add a number of additional benefits and plan structures, and charge a premium for enrolling. You must be enrolled in both Part A and Part B to be eligible for Part C. Some Medicare Advantage plans also offer prescription drug coverage.
You do not need to buy Medigap, or Medicare Supplement insurance if you enroll in Medicare Advantage. There is a premium for Part C.
Medicare Part D
Medicare Part D covers prescription drugs. Specifically, it covers FDA approved, medically necessary drugs used for the purpose for which they have been tested and approved. Part D does not cover "off label" uses for drugs. There is no standard list of covered drugs, however. Instead, individuals contract with a private plan for Medicare Part D benefits, and use the formulary established by that plan. Medicare Part D covers both brand name and generic drugs.
What is not covered
Medicare does not cover acupuncture or other alternative health therapies, dental care or dentures (except when medically necessary), cosmetic, elective surgery, orthopedic shoes, routine foot care or eye care, or routine checkups, although your Medicare Advantage plan may provide coverage for some of these items. Medicare does not normally pay for long term care, except for the first 100 days after a qualifying hospitalization. Medicare does not cover non-emergency care abroad.
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