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What Everybody Ought To Know About Medicare

Think you know everything about Medicare? You might be surprised. Medicare is an important part of healthcare for millions of Americans, and it’s crucial to understand how it works before…

September 20, 2022

Written by Gary Martin

Think you know everything about Medicare? You might be surprised. Medicare is an important part of healthcare for millions of Americans, and it’s crucial to understand how it works before you sign up. But with so many myths and misconceptions, it can be tough to keep track of what’s fact and fiction. 


In this blog post, we’re going to break down some of the basics so that you can make informed decisions about your coverage. So read on about this vital program!

What Is Medicare?

Medicare is a program that provides health coverage for seniors, younger people with certain disabilities, and people with End-Stage Renal Disease (ESRD) or Lou Gehrig’s disease (ALS). It’s administered by the Centers for Medicare & Medicaid Services (CMS), a part of the U.S. Department of Health and Human Services (HHS). 

How Does Medicare Work?

Medicare is a crucial safety net for Americans who might otherwise be unable to afford health care. In addition to providing basic coverage, it also helps keep costs down by negotiating with hospitals and doctors on behalf of beneficiaries.


Once enrolled, individuals can receive coverage for various services, including doctor visits, hospital stays, lab tests, and preventive care. In most cases, Medicare recipients are responsible for paying a monthly premium, deductibles, and coinsurance for covered services.

Who Is Eligible For Medicare?

To be eligible, a person must:


  • Be a U.S. citizen
  • Be a legal permanent resident of at least five years
  • Be 65 years of age or older
  • Suffer from Lou Gehrig’s disease
  • Suffer from End-Stage Renal Disease


Those that receive Social Security benefits are automatically eligible for parts A and B once they reach the required age. Those under 65 can also be eligible if they receive Social Security Disability Insurance (SSDI).


The Multiple Parts of Medicare Plans

Medicare comprises several parts, each with its own coverage and costs.

Part A: Hospitalization

Medicare Part A covers:


  • Hospital stays
  • Inpatient care
  • Skilled nursing facility care
  • Hospice care


There’s usually no monthly premium for those that qualify for Part A coverage. If you’re not one of them, you can still buy it. It tends to be lower than the premiums for other types of Medicare plans. 


There’s also a deductible and coinsurance associated. The patient might have to pay a deductible before Part A benefits kick in. After the deductible is met, the patient would be responsible for coinsurance, a percentage of the remaining bill.

Part B: Outpatient Services

Medicare Part B covers:


  • Doctor’s visits
  • Outpatient care
  • Home health care
  • Durable medical equipment
  • Preventive services.


If you’re not automatically enrolled in Plan B, you can sign up during the Initial Enrollment Period or a Special Enrollment Period. There’s a late enrollment penalty for those that don’t sign up when they’re first eligible.

Part C: Medicare Advantage Plans

Medicare Part C, also known as Medicare Advantage, bundles together Parts A, B, and D. It’s popular among those who want additional coverage beyond what Original Medicare (Part A and Part B) provides.


While each plan varies, most Medicare Advantage plans include Prescription drug coverage (Part D) and other benefits such as dental and vision care.


Part D: Prescription Drug Coverage

This plan helps to cover the cost of prescription drugs, and it also provides some protection against high prescription drug costs.


You need to consider the monthly premium, the annual deductible, the co-pays for each covered prescription, and the drugs covered by the plan formulary that Parts A or B don’t cover.

What Does Medicare Not Cover?

Despite the wide list of options and plans that Medicare offers, there are some limitations.

Medicare does not cover:


  • Long-term care
  • Hearing aids
  • Cosmetic surgery
  • Dental care
  • Vision care


As a result, beneficiaries may need to purchase supplemental insurance or pay out-of-pocket for these services.

The Step By Step To Enroll In Your Medicare Plan

Enrolling in Medicare can feel daunting, but it doesn’t have to be. With these few easy steps, you can ensure that you’re enrolled in the right plan for your needs:


  1. Decide whether you want Original Medicare or a Medicare Advantage plan. If you choose Original Medicare, you’ll enroll in Part A (hospital insurance) and Part B (medical insurance). If you opt for a Medicare Advantage plan, you’ll receive your Part A and Part B coverage through a private insurer.
  2. Start shopping around for plans. Consider premiums, deductibles, and copayments. It’s important to compare plans side-by-side to find the one that best meets your needs.
  3. Enroll in the plan of your choice. You can do this online, over the phone, or in person.

The Benefits of Acquiring A Medicare Plan

While Medicare does have premiums and out-of-pocket costs, it also offers many important benefits.


  • Helps you be prepared: It covers the costs of unexpected medical expenses
  • Saves you money: It can help beneficiaries cover preventive care services and offer discounts on prescription drugs
  • Gives you options to choose from: Medicare plans can provide the ability to see any doctor or specialist who accepts Medicare patients

Choosing The Best Plan For You

There is no single “best” way to receive Medicare coverage. The best option depends on each person’s individual circumstances and needs.


Remember that the information presented is just a starting point – for more details, you should consult an insurance agent. Once armed with the basics, you’ll be able to make a knowledgeable decision.

Secure Your Health and Tranquility

Some people may prefer the comprehensive coverage of a Medicare Advantage plan and others the flexibility of Original Medicare with a supplemental prescription drug plan. No matter what coverage you choose, at Nesso Senior Benefits, we can help you get the health care you need.


If you’re interested in enrolling, contact Nesso Group. With us, you’ll determine if you’re eligible for Medicare coverage and get complete information about what works best for you. 



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