What is Medicare?

What is Medicare?

Medicare is a federal government program created in the 1960s to help provide health care to individuals who are age 65 or older. Individuals below 65 who have been disabled for 24 consecutive months and those with end-stage renal disease (permanent kidney failure requiring dialysis or a transplant) are also eligible for Medicare.

The video below gives a short overview of Medicare. You can also view and download the official Medicare guide.

The Four Parts of Medicare

Medicare consists of four parts:

Part A covers in-hospital care. Part A is also called Hospital Insurance and includes treatment in hospitals, including a semi-private room, meals, supplies, and use of medical equipment. It also covers skilled nursing facilities, hospices, and at-home skilled nursing care such as physical, occupational, and speech therapy. Wheelchairs and walkers are also covered by Part A.

Part B, or Supplementary Medical Insurance, covers outpatient care. This includes doctors’ office visits, outpatient hospital care, lab tests, and medical devices like eyeglasses and prosthetic devices. Part B also covers some vaccinations and prescription drugs administered in doctors’ offices.

Part C consists of private health plans that administer Medicare benefits. Part C has mainly HMOs and PPOs that allow you to receive the benefits of the other parts together in one plan. These plans are called Medicare Advantage plans.

Part D, started in 2006, is the newest part. It covers prescription medications that you take at home, including insulin supplies and certain vaccines. Part D is available through several private insurance companies, each of which offers a different list of medications and costs. Alternatively, you can enroll in a Medicare Advantage (Part C) plan that also covers Part D medications.

What Medicare covers

Medicare covers most services that are considered “medically necessary.” Besides medical treatments, it covers some preventative screenings like pap smears, mammograms, bone density tests, colonoscopies, and screenings for heart disease, cancer, and diabetes.

But not all common services are covered. For example, Medicare doesn’t cover physical exams, routine vision, hearing and dental care. It also doesn’t cover nursing home care or medical services outside the United States. But, when you first sign up to Medicare Part B, you’re entitled to a one-time wellness checkup and history review within the first twelve months after signing up.

Is a test or treatment covered by Medicare? Find out here.

Under the Affordable Care Act, annual wellness checkups are included in Medicare. However these checkups are more like lifestyle counseling sessions with your physician than traditional physical exams. The doctor may check your height, weight, body mass, and blood pressure, but the bulk of the visit is discussion of your medical and family history, your health condition, and reducing risks of disease.

The next page describes Medicare premiums and co-pays. Alas, Medicare is not free.

Next: What Medicare costs