This is a presentation by Soraya Ghebleh that explains the major components of Medicare and the associated terms an individual would need to know to navigate the vast amount of information available on Medicare.
2. ¡ Medicare
is
a
federal
health
insurance
program
¡ It
covers
people
over
the
age
of
65,
people
with
disabilities,
and
people
with
end
stage
renal
disease
¡ Medicare
does
not
cover
all
health
care
needs
but
does
cover
most
medically
necessary
services
¡ Medicare
is
divided
into
four
parts:
Part
A,
Part
B,
Part
C,
and
Part
D
3. ¡ Part
A
is
for
hospital
insurance,
paying
for
most
inpatient
hospital
care
and
some
inpatient
skilled
nursing
facilities
¡ Individuals
are
automatically
enrolled
in
Part
A
when
they
join
Medicare
¡ If
you
automatically
qualify
for
Medicare,
you
do
not
have
to
pay
a
monthly
premium
4. ¡ Part
B
pays
for
doctors’
services,
outpatient
hospital
care,
outpatient
physical
and
speech
therapy,
some
home
health
care,
ambulance
services,
and
some
medical
equipment
and
supplies
¡ Part
B
is
voluntary
and
the
monthly
premium
is
automatically
deducted
from
monthly
Social
Security
checks
¡ If
you
do
not
receive
Social
Security,
you
will
be
billed
for
Part
B
5. ¡ Part
C
combines
A,
B,
and
D
into
an
HMO
or
a
PPO
with
a
private
insurer
¡ Part
C
governs
the
way
Medicare
benefits
are
provided
by
companies
that
contract
with
the
Medicare
program
¡ Individuals
enrolled
in
a
Medicare
Advantage
plan
receive
all
of
their
medical
savings
through
that
plan
¡ HMOs
and
PPOs
contract
with
Medicare
to
provide
Medicare
benefits
in
a
managed
care
setting
¡ You
must
pay
the
Part
B
premium
in
order
to
qualify
for
a
Medicare
Advantage
Plan
6. ¡ Part
D
refers
to
Medicare
prescription
drug
coverage
and
can
often
be
a
stand-‐alone
plan
with
a
private
insurer
¡ Part
D
coverage
is
voluntary
and
the
monthly
premium
depends
on
how
much
coverage
an
individual
has
7. ¡ Medigap
is
also
known
as
supplemental
insurance
¡ Generally
individuals
who
buy
a
Medigap
policy
also
have
Medicare
Part
A
and
Part
B
and
the
Part
B
premium
must
be
paid
¡ Medigap
policies
are
health
insurance
sold
by
private
insurance
companies
to
fill
the
“gaps”
in
the
original
Medicare
Plan
coverage
¡ Costly,
but
often
very
useful
8. An
agreement
with
a
doctor
to
be
paid
directly
by
Medicare,
accept
the
payment
amount
Medicare
approves
for
the
service,
and
not
bill
you
anything
other
than
the
Medicare
deductible
and
coinsurance.
9. The
amount
you
have
to
pay
for
medical
services
after
paying
any
deductibles.
Coinsurance
is
usually
a
percentage
of
the
service.
So
if
you
have
a
$10,000
doctor
bill
after
deductibles
and
a
20
percent
coinsurance
rate,
Medicare
would
pay
$8,000
and
you
would
pay
$2,000.
10. The
amount
you
have
to
pay
for
a
medical
service
or
supply,
for
example,
a
doctor’s
visit
or
a
prescription.
A
co-‐payment
is
usually
a
set
amount,
such
as
$10
or
$20.
11. The
amount
you
have
to
pay
for
health
care
or
prescriptions
before
Original
Medicare,
your
prescription
drug
plan,
or
other
insurance
kicks
in.
12. The
amount
over
the
approved
Medicare
payment
that
some
doctors
and
other
health-‐
care
providers
can
charge
you
under
Original
Medicare.
13. Also
called
“Medigap
Protections.”
Means
that
Medigap
plans
can’t
deny
you
a
Medigap
policy,
refuse
to
cover
preexisting
conditions,
or
charge
you
more
for
the
policy
based
on
your
age
or
medical
status
if
you
buy
the
policy
within
six
months
of
signing
on
for
Medicare
Part
B.
14. Insurance
companies
can’t
cancel
your
Medigap
policy
unless
you
lie
on
your
application,
commit
fraud,
or
don’t
pay
your
premiums.
All
Medigap
policies
issued
since
1992
are
guaranteed
renewable.
15. A
joint
federal
and
state
health
insurance
program
for
those
who
meet
certain
financial
requirements.
16. The
maximum
amount
that
doctors
who
accept
a
Medicare
assignment
can
be
paid
for
a
service.
In
other
words,
they
can’t
bill
you
any
extra.
17. A
Medicare
Advantage
plan
that
combines
a
high
deductible
with
a
medical
savings
account.
The
plan
deposits
money
each
year
into
your
account.
You
do
not
pay
any
taxes
on
the
money
or
the
interest
it
earns
as
long
as
you
use
it
for
health-‐care
costs,
including
those
that
aren’t
covered
by
Medicare.
Any
money
left
in
the
account
at
the
end
of
the
year
can
still
be
used
for
medical
costs
in
future
years.
Unlike
non-‐Medicare
medical
savings
accounts,
you
cannot
deposit
any
money
into
this
account.
18. A
type
of
Medicare
Advantage
(Part
C)
plan
in
which
you
can
see
the
same
doctors
and
use
the
same
hospitals
as
someone
with
Original
Medicare.
However,
because
the
plan
determines
how
much
it
will
pay
doctors
and
hospitals
and
how
much
you
must
pay
when
you
receive
care,
you
may
pay
more
(or
less)
for
Medicare-‐covered
benefits
than
if
you
had
Original
Medicare.
19. A
type
of
Medigap
policy
that
may
require
you
to
use
hospitals
and,
in
some
cases,
doctors,
within
its
network
to
be
eligible
for
full
benefits.
20. A
health
problem
you
had
or
have
before
a
new
insurance
policy
starts.
21. A
monthly
fee
paid
to
Medicare,
an
insurance
company,
or
a
health-‐care
plan
to
maintain
your
insurance
coverage.
22. Health
care
to
prevent
illness
or
detect
illness
at
an
early
stage.
Screening
mammograms,
flu
and
pneumonia
vaccines,
and
Pap
tests
are
examples
of
preventive
services.
23. Someone
entitled
to
Medicare
Part
A,
whose
income
is
not
higher
than
the
Federal
Poverty
Level,
and
whose
resources
(i.e.,
a
house,
car,
etc.)
do
not
exceed
twice
the
Supplemental
Security
Income
level.
These
people
are
eligible
to
have
their
state
Medicaid
system
pay
their
Medicare
premiums,
deductibles,
coinsurance
and
co-‐payment
amounts
(except
for
Part
D).
24. State
programs
that
provide
free
local
health
insurance
counseling
to
people
with
Medicare.
The
federal
government
funds
these
programs.