Understanding Medicare in North Carolina
Medicare Eligibility: Medicare is a federal health insurance program for:
- People age 65 and older
- People under 65 with certain disabilities
- People of any age with End-Stage Renal Disease (ERSD)
Parts of Medicare:Medicare is divided into separate parts, each part serving its own purpose and covering specific areas of health care.
Medicare Part A
Medicare Part A is premium-free to those who qualify through Social Security, railroad retirement or government employment and it is financed by the payroll tax (FICA). People under age 65 who have been disabled for 24 months and receive Social Security disability benefits qualify for Medicare Part A as well. Individuals over age 65 who do not qualify through Social Security, railroad retirement or government employment may still receive Part A by paying a monthly premium.
Part A Covers:
- Hospitalization
- Post-hospital Skilled Nursing Facility Care
- Home Health Care
- Hospice Care
- Psychiatric Care
Medicare Part B
Medicare Part B is optional and offered to all applicants when they become eligible for Part A either by qualification or premium. All Part B participants pay a monthly premium and annual deductible for services.
Part B Covers:
- Medical Expenses
- Clinical Laboratory Services
- Home Health Care
- Outpatient Hospital Treatment
- Blood (except the first 3 pints per benefit period)
Medicare Part C or Medicare Advantage
Medicare Part C, also known as Medicare Advantage plans, are provided by private insurance companies contracted with Medicare. These plans package the benefits and services of Part A and Part B into one plan and usually include prescription drug (Part D) coverage. Although Part C is an alternative to Part A and Part B, you must be enrolled in Part A and Part B to be eligible.
Part C Covers:
- All benefits of Part A
- All benefits of Part B
- Usually includes Prescription Drug benefits or Part D coverage
- Provides a yearly limit on out-of-pocket covered medical expenses
Medicare Part D
Medicare Part D is prescription drug coverage.These plans are provided by private insurance companies contracted with Medicare.
Medicare Supplement Insurance or Medigap
Medicare Supplement plans are designed to fill gaps in coverage that exist within Medicare Part A and Part B. These plans are offered by private insurance companies and are not a government benefit. Medicare Supplement plans are not a required option; however, they are usually recommended due to potential high out of pocket cost when only covered by Original Medicare (Part A and Part B).
To discuss Medicare Parts and Plans further, please contact the knowledgeable and friendly professionals at NC Health Plans at 888-765-5400.