What Is Medicare?

Medicare is health insurance for people age 65 and older, under 65 with certain disabilities, any age with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS). Medicare has different parts that cover different things: Part A covers inpatient hospital, some skilled nursing, hospice and home health care. Part B covers doctors' services and outpatient care, and some preventative services.

Medicare also subsidizes and regulates private drug insurance plans, called Part D, available to everyone with Medicare Part A and/or Part B.

Medicare members may choose to have "original Medicare" as their insurer; some people with "original Medicare" also have a private form of insurance to supplement their Medicare, known as a "Medicare Supplement" or a "Medigap." People with limited income and resources may have Medicaid as their supplemental insurer, and people with retirement plans may have those plans as their supplement.

Alternatively, some people have their health coverage run by private companies approved by Medicare, including Part A and Part B benefits. The latter are known as "Medicare Advantage Plans," and include HMOs, PPOs, etc.

The official government handbook, "Medicare & You," includes sections on Medicare coverage choices, choosing a prescription plan, financial assistance, your Medicare rights, and more. 

Nebraska SHIIP (Senior Health Insurance Information Program) (www.doi.nebraska.gov/shiip/) educates people with Medicare, assisting seniors and people with disabilities in making informed decisions about health insurance. For more information on this program, call 800-234-7119.

How can consumer resources be helpful?

Issues that some Medicare members seek assistance with include explanations of benefits, explanation of consumer insurance choices, coordination of insurances, enrollment and disenrollment from Medicare and related insurances, claims disputes, and plan comparisons of for Part D.

 
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