A Beginner’s Guide to Understanding Medicare

Medicare is one of the federal / state health insurance programs available in the United States. It is eligible for use by those who are age 65 and older. While it does cover certain younger people with disabilities and people with End-Stage Renal Disease (ESRD) the majority of Medicare is utilized by over 60 million seniors who are over the age of 65.

When should I enroll in Medicare?

You should enroll in Medicare immediately when you turn 65 years of age. If you do not enroll or are enrolling late, there are monetary penalties depending on the program. However, there are ways to avoid these penalties. This includes continuing to work past your 65th birthday and holding health insurance through your employer as well as volunteering in a foreign country during your initial enrollment period.

How do I sign up for Medicare?

To enroll in Medicare, apply on the United States Social Security Administration’s website. Medicare provides the coverage, but you will need to apply and enroll through the Social Security Administration to see if you’re eligible for Medicare. Click here to visit the Social Security Administration’s website.

How Does Medicare Work?

Medicare consists of different “Parts” that cover specific healthcare services. Depending on your current healthcare needs and anticipated needs, Medicare is easily buildable to create a program that is correct for you. There are two programs to begin with, then build off of – Original Medicare and Medicare Advantage. Most healthcare plans cover a certain limit of services and then begin to charge a co-insurance, deductible, or daily rate depending on the situation. When enrolling, speak with your healthcare provider regarding the options and they will be able to assist and provide important information when choosing the plan that is correct for you.

How Does Medicare Work?

What does Medicare cover?

hospital insurance
Part A (Hospital Insurance)

In general, Medicare Part A covers inpatient care in hospitals, skilled nursing facility care, hospice care, medically necessary inpatient rehabilitation, acute care rehabilitation, and home health care.

Part B (Medical Insurance)

Medicare Part B is used to cover services or supplies that are needed to diagnose or treat your medical condition. Additionally, it is used to cover some healthcare costs including preventative services (screenings, vaccinations, yearly checkups), outpatient care, home health care, clinical research, mental health services, limited prescription drugs, durable medical equipment like walkers, wheelchairs, hospital beds and more.

medical insurance
Part A (Hospital Insurance) and Part B (Medical Insurance) do NOT cover:

  • Long-Term Care (also called custodial care)
  • Most dental care
  • Eye exams related to prescribing glasses
  • Dentures
  • Hearing aids and exams for fitting them
  • Routine foot care
  • Cosmetic surgery
  • Acupuncture

Part C (Medicare Advantage Plan)
See Medicare Plans below.

Part D (Prescription Drug Coverage)

While some prescriptions are covered as a part of Medicare A, Medicare Part D helps to cover the cost of prescription drugs. This may help individuals lower their drug costs and help protect against higher costs in the future. All plans within Medicare cover a wide range of prescription drugs that people take, including most drugs in certain protected classes (for cancer or HIV/AIDS treatment).

To learn what Medicare Part D drug plans cover, click here.

Prescription Drug Coverage

Does Medicare Cover Rehabilitation?

Under Medicare Part A, medically necessary inpatient rehabilitation is fully covered for up to 20 days (if your Part A deductible is met). Individuals will pay a per-day charge set by Medicare for days 21-100 during each benefit period and 100% of costs for days 101 and beyond.

Participating in rehabilitation will assist you in recovering from serious injuries, post-surgery needs, or illness. However, your doctor needs to affirm that your medical condition requires intensive rehabilitation, needs continued medical supervision, and needs coordinated care from your doctors and therapists (occupational therapy, physical therapy, speech-language therapy) who are working together.

Inpatient Acute Care Rehabilitation in Pawleys Island, South Carolina

The Lakes at Litchfield is a Continuing Care Retirement Community (CCRC) located on Pawleys Island, South Carolina. As a CCRC, the community offers a full continuum of care services including Independent Living, Assisted Living, Memory Care, Skilled Nursing, and Rehabilitation Services. Unlike traditional standalone rehabilitation centers, The Lakes at Litchfield provides a luxury home-like setting with freshly prepared meals, social events, wellness programs, and on-site rehabilitation services.

Medicare Part A is accepted by The Lakes at Litchfield for rehabilitation services and it’s the top choice in the area for those who are looking for a private and upscale setting to participate in rehabilitation. On-site physical therapy, speech therapy, and occupational therapy allows individuals to easily access treatment.

To learn more about rehabilitation at The Lakes at Litchfield, click here or call (843) 314-1395.

Medicare Plans

Medicare plans can be tailored to fit your needs, though most individuals choose the inclusive packages of Original Medicare and Medicare Advantage. While Medigap is supplemental to fill in for additional costs that may arise.

Original Medicare (Medicare Part A + Medicare Part B)

This is the simplest and most basic form of Medicare. Those who opt for this program receive Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance). Original Medicare pays for a wide variety of services, but the entire cost of services and supplies may not be covered. If it is not, this is an opportunity to add Medicare Part D (Prescription Drug Coverage), Medicare Supplement Insurance (Medigap). To learn more about what Original Medicare covers, click here.

Medicare Advantage (Medicare Part C)

Known as ‘Medicare C’, Medicare Advantage is an all-in-one alternative to Original Medicare. Provided through a private company, Medicare Advantage is bundled to include Part A, Part B, and usually Part D. Additionally, this plan may offer extra benefits that Original Medicare doesn’t cover like health and wellness programs, vision, hearing, and dental services. To learn more about Medicare Advantage, click here.

Medicare Supplement Insurance (Medigap)

Medicare Supplement Insurance helps fill “gaps” in Original Medicare and is sold by private companies. Original Medicare pays for much, but not all, of the cost for health care services and supplies. It can help pay for some remaining healthcare costs including: copayments, coinsurance, deductibles. To learn more about what Medicare Supplement Insurance covers, click here.

Medicare Plans

How do I enroll in Medicare?

When you are ready to sign up, contact the Social Security Administration (or Railroad Retirement Board, if applicable):

  • To apply online for Medicare, click here.
  • Call the Social Security Administration at 1-800-772-1213.
  • Contact your local Social Security office.
  • If you or your spouse worked for a railroad, call the Railroad Retirement Board at 1-877-772-5772.

Official Medicare Resources:

United States Medicare Website: Medicare.gov
United States Medicare Phone Number: 1-800-633-4227
United States Social Security Administration: https://www.ssa.gov/
United States Social Security Administration Phone Number: 1-800-772-1213
Disclaimer: The information above should function as a starting point for your Medicare and Insurance research but should not be substituted for advice from an official Medicare representative, and licensed healthcare professionals. Medicare is ever-changing and this information may not be up to date with current Medicare policies and coverage. For complete Medicare information, visit Medicare’s official website at https://www.medicare.gov/