AHIP Medicare - Module - 1 Overview of Medicare Program Basics
Coverage is available through Original Medicare (fee-for-service) or private plans, with Part D drug coverage always provided through private plans. Covers inpatient hospital care, skilled nursing, rehab, and hospice.
What is Medicare?
Medicare is the Federal health insurance program for individuals who are aged (65 and over and younger individuals who have certain health conditions or are disabled.
Medicare eligibility does not take into consideration an individual’s income.
However,
–individuals may pay higher premiums based on income, and
–low-income individuals may be eligible for additional assistance.
individuals can receive their Medicare medical coverage:
– directly from the Federal Government, which pays for services on a fee-for-service basis (this program is known as “Original Medicare” or “Fee-for-Service Medicare”); or
– through a private health plan.
Individuals must receive their Medicare Part D outpatient drug benefits through a private health plan (even if they get their medical coverage through Original Medicare).
Key Terms
What is Medicare?
Medicare is the Federal health insurance program for individuals who are aged (65 and over and younger individuals who h...
Parts of Medicare Coverage:
– Part A is referred to as “Hospital Insurance Benefits.” Part A also covers other inpatient care, including skilled nur...
What is Medicare Part E?
– There is also a lesser-known Part E of Medicare law that regulates other miscellaneous programs including:
- Medica...
Different Ways to Get Medicare:
There are different ways that beneficiaries can choose to receive their Medicare coverage.
– Original Medicare (Part ...
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| Term | Definition |
|---|---|
What is Medicare? | Medicare is the Federal health insurance program for individuals who are aged (65 and over and younger individuals who have certain health conditions or are disabled. Medicare eligibility does not take into consideration an individual’s income. However, –individuals may pay higher premiums based on income, and –low-income individuals may be eligible for additional assistance. individuals can receive their Medicare medical coverage: – directly from the Federal Government, which pays for services on a fee-for-service basis (this program is known as “Original Medicare” or “Fee-for-Service Medicare”); or – through a private health plan. Individuals must receive their Medicare Part D outpatient drug benefits through a private health plan (even if they get their medical coverage through Original Medicare). |
Parts of Medicare Coverage: | – Part A is referred to as “Hospital Insurance Benefits.” Part A also covers other inpatient care, including skilled nursing facilities, rehabilitation facilities, and hospice. – Part B is referred to as Supplementary Medical Insurance Benefits.” Part B covers a broad range of outpatient services such as physician care, and drugs that are administered by physicians or other health care professionals (such as certain vaccines and intravenous medications). – Part C regulates and authorizes Medicare Advantage plans, which must cover Part A (except for hospice) and Part B benefits. – Part D covers prescription drug benefits (for self-administered drugs, such as those picked up at a pharmacy and taken at home) and regulates Medicare prescription drug plans. |
What is Medicare Part E? | – There is also a lesser-known Part E of Medicare law that regulates other miscellaneous programs including: |
Different Ways to Get Medicare: | There are different ways that beneficiaries can choose to receive their Medicare coverage. |