Senior Primer on Medicare Health Coverage, Part 1

For community staff with Avamere at Mountain Ridge and our numerous assisted living community programs, medical care and attention are constantly some of the top priorities. Proper medical staff are a mainstay in our communities, for starters, and we’re also highly cognizant of any special needs, programs or other variables for any area of senior medical care or coverage.

Within this latter area, there’s one term that’s familiar to a great number of seniors and their family members: Medicare. Created in 1965 and designed specifically for adults over age 65, Medicare has undergone many changes in the decades since it was created – but still plays a vital role for many seniors in their health coverage and care. This two-part blog series will offer a general primer on Medicare for seniors and their families or caregivers, including all the relevant areas to be aware of and the different options available.

Medicare Basics

Medicare, which is managed by the Social Security Administration within the federal government, is in charge of providing basic healthcare services to over 60 million seniors and people with disabilities. Covering areas ranging from simple physicals and yearly care to functional conditions, impairment issues, cognitive decline, long-term disability and more.

Medicare covers a huge range of health services and types. It also covers prescription drugs and various outpatient services, even including home health and hospice. Later in this series, we’ll detail a few areas that may not be covered by Medicare, just so you’re aware.

Qualifying for Medicare

The following qualifications must be met to qualify for Medicare:

• Must be a US citizen or green card holder
• Must be at least 65 years of age, deemed disabled, or diagnosed with a qualifying medical condition

Qualification will vary somewhat based on age and specific health status, which will also play a role in which type of Medicare coverage a given individual needs. This is referred to as a Medicare part, which we’ll go over below.

Medicare Parts

Medicare coverage can be obtained in two ways: Original Medicare, which includes parts A and B, and Medicare Advantage, sometimes called Part C. Part D, in addition, covers prescription drugs. Some quick basics on each part type:

• Part A: Basic inpatient benefit that’s afforded to virtually every beneficiary at age 65, covering themes like hospital care, rehabilitation, nursing home care, home care and hospice service. The majority of adults are automatically enrolled in Part A.
• Part B: Covering outpatient benefits, Part B is generally optional based on the fact that it charges monthly premiums. Part B covers a wider range of services, from research and outpatient services to certain drugs or disposable equipment.
• Part C: Another term for Medicare Advantage, which is a coverage option that combines Parts A and B into a single plan – and goes through private insurance companies. In addition, some Part C plans offer additional services that aren’t covered under A or B.
• Part D: Finally, Medicare Part D is the prescription drug benefit. It is the most recent addition to Medicare, added in 2006, and is optional – purchased as a separate standalone policy with a monthly premium.

For more on Medicare coverage, or to learn about any of our assisted living, memory care or other senior living community services, speak to the staff at Avamere at Mountain Ridge today.