Rehab Select Blog

Understanding Health Benefits: An Overview of Government Healthcare

Posted by Bobby Stephenson

Nov 13, 2014 8:00:00 AM

Understanding_Health_BenefitsAttempting to understand government healthcare often brings about confusion and stress, especially for those who are unfamiliar with the different kinds of federal medical coverage available. One of the most important things to know when it comes to understanding health benefits from the government is what separates the various plans that are available.

Understanding Health Benefits of Medicare

Medicare is the common name for the government’s health insurance program. Medicare coverage is available for either elderly people over the age of 65, or younger people who have disabilities.

Understanding health benefits from the government requires a knowledge of the different kinds of Medicare. Generally, Medicare is broken down into two types: Medicare Part A and Medicare Part B. There are some key differences between these two types of coverage, based on which forms of healthcare they provide compensation. 

Medicare Part A

Part A is the part of Medicare that usually covers general healthcare, including doctor appointments, hospital trips, in-home nursing care, and treatment at skilled nursing facilities. To qualify for Part A, you must have ten years of employment covered by Medicare.

Medicare Part B

Part B is an optional program put in place to cover the things that Medicare Part A does not cover. While Medicare Part B provides coverage for the same type of healthcare services that Part A provides, it also offers insurance for supplies that are considered medically required for your health. Part B also offers the benefit of covering preventative services, such as screenings for diseases like diabetes and breast cancer. Unlike Part A, Medicare Part B requires participants to pay a monthly premium. The cost of the premium depends on your financial situation: it is calculated differently from state-to-state.

Medicare Part D

Part D is one of the newer types of Medicare. It is the portion of Medicare that covers the cost of prescription drugs. Under Medicare Part D, prescription drugs are broken down into different tiers based on how they are used. Drugs in different tiers cost different amounts of money. Because Part D is administered by private organizations, its costs vary depending on which state you live in. Each particular plan will have its own set of tiers and its own rules that state exactly what the plan covers and what the quantity limits are for prescription drugs.

Medicare Advantage (Medicare Part C)

Medicare Advantage is sometimes known as Medicare Part C. With this type of Medicare coverage, participants contract out the coverage normally provided in parts A and B to private companies that are approved by Medicare. Most of the time, you will also get the same coverage you get from Part D through Medicare Advantage plans: for this reason, if you already have Part D you are not allowed to participate in Medicare Advantage prescription plans.

The two most common kinds of Medicare Advantage plans are health maintenance organizations (HMOs) and preferred provider organizations (PPOs). With an HMO, you will have to visit healthcare providers in your chosen network. A PPO allows you to go outside of the network, but you will still face higher costs out of pocket.

This is a basic overview of the different kinds of health benefits available from the government. To get further help with understanding health benefits, contact your healthcare providers or Medicare representatives in your state. 

Understanding Senior Health Benefits

Topics: Paying for Care