The Medicare Program

In 1965 President Johnson enacted Medicare for seniors to have the opportunity to obtain affordable healthcare. There have been many improvements over the years.

The Centers for Medicare and Medicaid Services (CMS), a part of the Department of Health and Human Services (HHS), administers the Federal Medicare Program.

The Social Security Administration is responsible for determining eligibility and processing premium payments for the Medicare program. You enroll in Medicare at the Social Security office.

Quite simply Medicare consists of four parts. The 4 parts are A, B, C and D. To make it easy just remember D is for “Drugs”.

Part A helps cover inpatient care in hospitals, including critical care hospitals, and skilled nursing facilities. Part A also covers hospice care and home health care. This is not blanket coverage; certain restrictions may apply to get some of these benefits.

Part B helps cover medical services like outpatient care, doctors’ services, and some other medical services that Part A does not cover. Part B covers medically necessary services. Part B may also cover some preventive services.

Part C, formerly known as is Medicare + Choice is now known as Medicare Advantage. If you are entitled to Part A and enrolled in Part B, you are eligible to enroll in a Medicare Advantage plan, provided you live in the plan's service area.
Medicare Advantage Plans include:
 
Preferred Provider Organization (PPO) Plans;
Health Maintenance Organization (HMO) Plans;
Private Fee-for-Service (PFFS) Plans;
Special Needs Plans,
and Medicare Medical Savings Account (MSA) Plans.

These plans are offered by private insurance companies and usually offer additional benefits and lower co-pays than Original Medicare. The Centers For Medicare And Medicaid Services (CMS) must approve all plans.

If you have Medicare Part A, Part B or a Medicare Advantage Plan (Part C), you are eligible for prescription drug coverage—Part D. Although this prescription insurance is optional, if you decide not to enroll when you are first eligible, you may pay a penalty if you choose to join later.

Private insurance companies offer part D plans and you may pay a small monthly premium in addition to the Medicare B premium. The Center For Medicare And Medicaid Services (CMS) must approve plans.  The average additional monthly premium for Part D coverage is around $35. You have many choices for Medicare plans so be sure to make an informed opinion.

Medicare Savings Programs offer assistance to people with limited income and resources. These programs pay Medicare premiums and, in some cases, Part A and Part B deductibles and co-insurances.

Medigap policy (also known as Supplement Insurance) is a health insurance policy designed to supplement the Original Medicare Plan. Medigap policies help pay some of the health care costs that Original Medicare does not cover, such as deductibles, co-pays or co-insurance. Medigap policies are offered through private insurance companies. Underwriting guidelines vary depending on your state. In New York State, Medigap policies may be purchased at any time.