Our nation’s Medicare and Medicaid programs were created with the enactment of The Social Security Amendments of 1965. They are overseen by the Center for Medicare and Medicaid Services (CMS). The following terms and information will prove helpful if you or a loved one are eligible to receive benefits through these federal programs.
- Medicare: Federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).
- Medicare Fee for Service: Original Medicare. Includes Part A and B
- Medicare Part A (Hospital Insurance): covers inpatient hospital stays, care ina skilled nursing facility, hospice care, and some home healthcare.
- Medicare Part B (Medical Insurance): covers certain doctors’ services, outpatient care, medical supplies, and preventive services.
- Medicare Part C– Medicare Advantage Plans: a type of Medicare health plan offered by a private company that contracts with Medicare to provide Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. Services are covered through the plan and aren’t paid for under Original Medicare.
- Medicare Special Needs Plan (SNP): A special type of Medicare Advantage Plan (Part C) that provides more focused and specialized healthcare for specific groups of people, like those who have both Medicare and Medicaid, who live in a nursing home, or have certain chronic medical conditions.
- Medicare Part D – Prescription drug coverage: Medicare offers prescription drug coverage to everyone with Medicare. If you decide not to join a Medicare Prescription Drug Plan when you’re first eligible, and you don’t have other creditable prescription drug coverage, or you don’t get Extra Help, you’ll likely pay a late enrollment penalty. To obtain Medicare drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and drugs covered.
If you choose Original Medicare.
If you want this coverage, you must choose and join a Medicare Prescription Drug Plan. You usually pay a monthly premium. These plans are run by private companies approved by Medicare.
If you choose a Medicare Advantage Plan.
If you want prescription drug coverage, and it’s offered by your plan, in most cases you must get it through your plan.
In some types of plans that don’t offer drug coverage, you can join a Medicare Prescription Drug Plan.
