The federal government-based program that is in charge of providing health care coverage or health insurance for those above 65 is called Medicare. This is also applied to those who are getting SSDI or social security disability insurance and are under the age of 65 for a specific period of time or those with ESRD or end-stage renal disease and aren’t over 65. CMS or the Centers for Medicare & Medicaid Services runs the Medicare program and it is a federal agency and it is partly funded by Medicare taxes that are paid over the years on your income and Social Security. It can also be funded through premiums that are paid as well as partly by the current federal budget.

Once you are eligible for Medicare and have enrolled, then you can pick what benefits you want from the Original Medicare, which is the federal government fee-for-service based program. You can also choose from Medicare Advantage Plan, which is coverage that is offered by private insurance companies that are often contracted with Medicare.

The Original Medicare has different parts, including:

  • Part A (Inpatient/hospital coverage)
  • Part B (Outpatient/medical coverage)

If you want coverage for prescription drugs from Medicare, then you need to get Part D that would work with the Original Medicare. You would need to choose and then join a private plan for drug coverage that is stand-alone and not part of the Medicare coverage.

You will still have the coverage from Medicare even if you have enrolled in one of the Advantage plans. However, this means that you would have to pay a premium for Part B along with the Part A cost, if there is one. The Advantage plans needs to have all of the services that would be covered by the Original Medicare in Parts A as well as B, but it can do it with different restrictions, costs and rules.

The Advantage plans would also provide coverage for Part D and if you have health insurance from your former or current employee or through any union when you become eligible, then you might be automatically enrolled in an Advantage plan that they might sponsor. You would be able to decide if you want to stay with your current plan, enroll in a different Advantage plan or even change to the Original Medicare. However, you need to speak to the union or employer before any change is made.

You need to understand what the choices you have are for Medicare coverage and how to choose the right coverage. How you make this decision as well as who they are from would affect your out-of-pocket expenses and where you can get the care from. Original Medicare would cover you to go to almost all of the hospitals and doctors in the US, but some plans like Advantage plans would have restrictions regarding the network.

Also, the Advantage plans would have additional benefits that you can get that the Original Medicare doesn’t have, including dental and vision care. Those who have Medicare would get a blue, white and red card for Original Medicare. If you chose to get your coverage through this method, then you just need to show the card when you are availing the services. However, if you are using the Advantage plans you should show your Advantage card and not the Original card.

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