The Q Series: Quality Health Care Answers
The Q Series: A series of informative blogs that explain the fundamentals of quality health care and emerging trends in healthcare delivery reform – this time on Medicare.
Q: What is Medicare?
A: The words "Medicare" and "Medicaid" sound so much that it's easy to confuse them. Most of us know that Medicare and Medicaid are two government programs that help pay for health care.
Medicare is generally intended for the elderly or disabled. Medicaid is for people with limited income and resources. This post will explain what is the health insurance and the different coverage options offered.
Medicare is a federal health insurance program for people aged 65 and over and for people under 65 who have certain disabilities. It can also cover people of any age who have permanent kidney failure requiring dialysis or kidney transplantation. Different parts of Medicare offer different types of coverage:
Medicare Part A: Hospital Coverage. When you apply for Medicare, you are automatically enrolled in the Part A plan. Part A helps pay for hospital and other institutional care and covers certain health services. home, specialized nursing care and palliative care.
Medicare Part B: Medical Coverage. Part B helps pay for medical expenses, including doctor visits and outpatient procedures – things that usually happen in a doctor's office or in an outpatient clinic. It also covers care that prevents you from getting sick, such as annual medical exams and flu shots. Part B is optional and requires registrants to make monthly premium payments. Some people choose not to register in Part B because they have health insurance from an employer.
Medicare Part C: Private Insurance. Also called "Medicare Advantage" plans, Part C plans are offered by private insurance companies. They offer all the benefits of Part A and Part B. Some offer additional benefits, such as hearing or dental coverage. Before you sign up for a Part C plan, you must first enroll in Parts A and B. The costs vary, and some plans require the payment of an additional premium. You choose the plan and you register directly with the private insurer.
Medicare Part D: Prescription Drug Option. Part D helps pay for prescription drugs, and it is optional for people listed in Parts A and B. Some Part C plans include coverage of Part D, others not. Part D plans are offered by private insurance companies. You register directly with the private insurer.
The different parts of Medicare (the types of insurance plans) are interconnected. In fact, you must be registered in Parts A and B to get Part C. You must be registered in Part A and / or Part B to get Part D Each plan varies according to the cost of premiums, coverage and the price of medicines.
Ready to sign up for Medicare, and wondering what would be the best plan for you? The NCQA has evaluated more than 1,300 health insurance plans. Notes include Medicare Part C plans, not Part A or Part B which are government programs. They are evaluated on how they treat illnesses and injuries, prevent members from getting sick and meet the expectations of members. The website of the 2015 NCQA Health Plan allows you to sort insurers by type of plan (Private, Medicare, Medicaid) and according to the state. Take a look today!
Shireesha Jevaji is Senior Policy and Communications Specialist at NCQA and has been with the organization since 2012. She supports NCQA's external communications to the consumer public and public and private stakeholders. She also performs data analysis for the production of infographics and publications and measures the impact of awareness. Shireesha is currently working on her MPH in Public Health Communication and Marketing at George Washington University.