Medicare Basics In Plain English: A Guide to Coverage, Eligibility, and Costs

Medicare is a health insurance program for people age 65 and older, as well as certain younger people with disabilities. It is administered by the Centers for Medicare & Medicaid Services (CMS),a federal agency within the U.S. Department of Health and Human Services.

Medicare is divided into four parts:

• Part A covers hospital insurance. This includes inpatient hospital stays, skilled nursing facility care, hospice care, and home health care.
• Part B covers medical insurance. This includes doctor visits, outpatient care, durable medical equipment, and certain preventive services.
• Part C is also known as Medicare Advantage. This is a private health insurance plan that provides Part A and Part B benefits, as well as additional benefits such as vision and dental coverage.
• Part D covers prescription drug coverage.

You are eligible for Medicare if you are:

Medicare Basics in Plain English

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• Age 65 or older
• Under age 65 and have a qualifying disability
• End-stage renal disease (ESRD)
• Amyotrophic lateral sclerosis (ALS)

If you are not eligible for Medicare based on your age or disability, you may be able to purchase Medicare Part A and/or Part B.

Medicare covers a wide range of health care services, including:

• Hospital stays
• Skilled nursing facility care
• Hospice care
• Home health care
• Doctor visits
• Outpatient care
• Durable medical equipment
• Certain preventive services
• Prescription drugs

Medicare does not cover all health care costs. For example, Medicare does not cover long-term care, such as nursing home care.

The cost of Medicare depends on which parts you have and your income.

• Part A is free for most people. If you have worked and paid Medicare taxes for at least 10 years, you will not have to pay a premium for Part A. If you have not worked long enough to qualify for premium-free Part A, you may have to pay a monthly premium.
• Part B has a monthly premium. The standard Part B premium for 2023 is $164.90. However, your premium may be higher if you have a high income.
• Part C plans have a monthly premium. The premium for a Part C plan varies depending on the plan you choose.
• Part D plans have a monthly premium. The premium for a Part D plan varies depending on the plan you choose.

In addition to premiums, you may also have to pay deductibles, coinsurance, and copays. A deductible is the amount you have to pay out-of-pocket before your insurance coverage begins. Coinsurance is the percentage of the cost of a covered service that you have to pay. A copay is a fixed amount that you have to pay for a covered service.

You can enroll in Medicare online, by phone, or by mail. You can also get help from a Medicare representative.

To enroll in Medicare online, visit the Medicare website at www.medicare.gov.

To enroll in Medicare by phone, call 1-800-MEDICARE (1-800-633-4227).

To enroll in Medicare by mail, complete the Medicare enrollment form (CMS-40B) and mail it to the Social Security Administration.

• Medicare website
• Social Security Administration website
• National Council on Aging website
• Medicare Rights Center website

I hope this article has helped you understand the basics of Medicare. If you have any questions, please contact Medicare or visit the Medicare website.

Medicare Basics in Plain English

by Brian Klemmer

4.6 out of 5

Language	:	English
File size	:	3871 KB
Text-to-Speech	:	Enabled
Screen Reader	:	Supported
Enhanced typesetting	:	Enabled
Word Wise	:	Enabled
Print length	:	68 pages
Lending	:	Enabled

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