The Q Series: Health Care Quality Answers – What is Medicare?

March 16, 2016 · Shireesha Jevaji

The Q Series: Health Care Quality Answers

The Q Series: A series of informative blog posts that explain the building blocks of health care quality and emerging trends in health care delivery reform – this time, on Medicare.


Q: What is Medicare?

A: The words “Medicare” and “Medicaid” sound so much alike that it’s easy to get them confused. Most of us know that Medicare and Medicaid are both government programs that help pay for health care.

Medicare is generally for people who are older or disabled. Medicaid is for people with limited income and resources. This post will walk you through what Medicare is and the different coverage options offered.

Medicare is a federal health insurance program for people 65 years of age and older and for people under 65 who have certain disabilities. It can also cover people of all ages who have permanent kidney failure that requires dialysis or a kidney transplant. Different parts of Medicare provide different kinds of coverage:

  • Medicare Part A: Hospital Coverage. When you apply to Medicare, you are automatically enrolled in the Part A plan. Part A helps pay hospital and other institutional care costs and covers some home health services, skilled nursing care and hospice care.
  • Medicare Part B: Medical Coverage. Part B helps pay for medical costs, including doctor visits and outpatient procedures—things that typically happen in a doctor’s office or a hospital outpatient clinic. It also covers care that keeps you from getting sick, such as annual physicals and flu shots. Part B is optional and requires enrollees to make monthly premium payments. Some people choose to not enroll in Part B because they have health insurance from an employer.
  • Medicare Part C: Private Insurance. Also called “Medicare Advantage” plans, Part C plans are offered through private insurance companies. They provide all Part A and Part B benefits. Some offer extra benefits like hearing or dental coverage. Before enrolling in a Part C plan, you must first enroll in Part A and Part B. Costs vary, and some plans require payment of an extra premium. You choose the plan and sign up directly with the private insurer.
  • Medicare Part D: Prescription Drug Option. Part D helps pay for prescription drugs, and is optional for people enrolled in Parts A and B. Some Part C plans include Part D drug coverage, others do not. Part D plans are offered by private insurance companies. You sign up directly with the private insurer.

Medicare’s various parts (the types of insurance plans) are interconnected—in fact, you must be enrolled in Parts A and B to get Part C. You must be enrolled in either Part A and/or Part B to get Part D. Each plan varies by cost of premiums, and by drug coverage and price.

Ready to sign up for Medicare, and wondering what the best plan would be for you? NCQA rated more than 1,300 health insurance plans. The ratings include Medicare Part C plans, not Parts A or B which are government programs. They are rated on how well they treat illness and injury, prevent members from getting sick and meet member expectations. NCQA’s Health Insurance Plan Ratings 2015-2016 web site lets you sort insurer by plan type (Private, Medicare, Medicaid) and by state. Take a look, today!

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