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Understanding the Basics of Medicare

Insurance can be costly, and trying to figure out all of the health-care options available to you can be exhausting and frustrating. Whether you are new to Medicare or simply interested in staying well informed, the following information will provide insight into the basics of this federal health insurance program.

Medicare is a government-funded health insurance program that provides medical coverage for people with disabilities, those over the age of 65, or those with end-stage renal disease (ESRD). This health insurance can be used as primary insurance or as supplemental “back-up” coverage.

The Basics of Part A and Part B

Medicare is designed to cover your essential medical needs—such as hospital stays and doctor visits—and the program is composed of four parts: Medicare Part A, Part B, Part C, and Part D. At the heart of Medicare is Part A and Part B, which are sometimes referred to as “classic Medicare.” These two parts provide for the majority of essential services. Here is what each part covers:

  • Part A: This section of Medicare covers your hospital care, including the initial hospital stay, meals, rooms, etc. This part also provides coverage for skilled nursing facility care, hospice, home health care, and nursing home care. For most people, this part of Medicare is premium-free, however determination of premiums is based largely on income, and high-income Medicare recipients may find that they are required to pay a small monthly premium in addition to standard medical fees.
  • Part B: This area of Medicare covers your general medical care, such as doctor visits, ambulance services, inpatient/outpatient mental health care, second opinions prior to surgery, medical equipment, and more. There is typically a premium for this section of Medicare coverage, and—as with Medicare Part A, the amount of the premium is largely based on income. Part B of Medicare focuses mainly on the precautionary and medically necessary aspects of health care, which is why premiums are typically required.

Additional Coverage Under Medicare

Medicare Part B also includes coverage and benefits for patients with cancer or diabetes, or those who are interested in smoking cessation programs. According to the American Cancer Society, Medicare will pay for one all-encompassing preventive doctor visit, which must take place within one year of enrolling in the Medicare Part B program. This provides a proverbial health baseline moving forward and is also an excellent time for patients new to Medicare to ask any questions they may have about their health both now and in the future.

Additionally, a yearly wellness exam is included in Medicare coverage. This allows people to receive vital screenings that could buy them valuable time if cancer, diabetes, or other health risks are detected. By offering preventive health checks, there is a better chance of treating cancer and other diseases before they pose an even greater threat at an advanced stage later on.

Smoking can act as a contributing factor to many illnesses, such as lung disease, cancer, heart disease, osteoporosis, and hypertension. Medicare now offers counseling service coverage for individuals who desire to quit smoking. This means that whether or not the patient’s condition is worsened by smoking, if they have Medicare and smoke, they are eligible for tobacco cessation counseling. Medicare Part D also offers prescription drug coverage that may help patients stop smoking via prescriptions that are effective at curbing tobacco cravings.

For Diabetes: The Mayo Clinic notes that this particular part of the Medicare plan allows those with diabetes to have coverage for things including:

  • blood glucose meters
  • blood glucose test strips
  • lancet devices
  • lancets
  • glucose control solution

Medicare also provides equipment such as walkers and wheelchairs, lab tests, and surgeries, when deemed medically necessary. For those who are concerned about preventive measures, Medicare Part B and its counterparts cover a vast array of precautionary testing, including up to two blood glucose lab tests per year. Some of the other tests include:

  • depression screenings
  • HIV screenings
  • mammograms
  • Pap tests and pelvic exams
  • prostate cancer screenings
  • cardiovascular disease screenings
  • obesity screenings

Medicare offers everyone a chance to lead healthier lives no matter their income level. While it covers a broad spectrum of tests, procedures, and preventive measures, there are a few areas that it does not cover, including:

  • hearing aids, or the fitting of hearing aids
  • long-term nursing care (custodial care)
  • routine dental care
  • eyeglasses
  • routine eye care
  • routine foot care
  • acupuncture
  • dentures
  • cosmetic surgery

If you are concerned about whether your desired service is covered by Medicare, you can speak directly with your physician, search the Medicare Coverage Database online at www.cms.gov, or contact the Medicare service center at 1-800-633-4227. 

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