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Most people have heard of Medicare, but the specific details of this federally funded program are not as familiar as the name. If you are a health insurance agent or an individual approaching the age of 65, you will want to learn more about Medicare benefits.

Medicare provides medical insurance for older adults and those who qualify with a disability. It is composed of two main parts, Part A, which is a hospital insurance plan; and Part B, which is supplementary medical insurance.

Every American that is 65 or older and entitled to Social Security is eligible for Medicare benefits. Benefits become available to the individual on the first day of the month of the individual’s 65th birthday. Individuals under age 65 who qualified for Social Security Disability for at least two years are also eligible for Medicare benefits. If you are unsure of your eligibility, you can contact the Office of Medicare Services.

Part A provides benefits for inpatient hospital services for up to 90 days in each benefit period. Benefits also include payment for prescription drugs only while in the hospital. It should be noted that there is no coverage provided for the first three pints of blood that the individual may have received while in the hospital.

Part A also includes limited skilled nursing care. Skilled nursing is provided for up to one hundred days, in which the first twenty days are paid for after the deductible is met. Days twenty one through one hundred fall under the coinsurance amount of coverage. Some home health services are provided, if deemed medically necessary. Hospice care and psychiatric inpatient treatment are also covered under Part A. Psychiatric hospital care covers up to one hundred ninety days during the individual’s lifetime.

Part B provides supplementary benefits and is a voluntary medical insurance plan. Part B pays benefits for physician and surgeon fees, medical services and supplies, outpatient hospital services, x-rays, lab tests, and other services such as ambulance service and durable medical equipment. For Part B benefits, individuals pay a monthly premium and have an annual deductible. Under this plan, there are certain exclusions such as: eye and hearing examinations, routine physical exams, foot care, immunizations and private nurses.

Part C are Medicare Advantage plans, which allow participants to opt out of the traditional Part A and B and enroll in a coordinated care HMO, PPO, PSO or a private fee for service plan. Health Maintenance Organizations (HMOs) require services to be provided by its own providers, except in an emergency. Preferred Provider Organizations (PPOs) allow beneficiaries to receive services from providers outside the plan, but with higher cost sharing. Provider Sponsored Organizations (PSOs) are similar to PPOs, but they are operated by a group of physicians and hospitals. Private fee for service plans are like PSOs but they may pay providers more than Medicare recognizes and can charge beneficiaries additional premiums and cost sharing payments.

If you are an individual approaching qualification for Medicare it is best to contact a health insurance agent that specializes in Medicare products. You may also want to contact your Medicare office or contact your local Area Agency on Aging.

Want to find out more about Medicare Advantage Plans, then visit Bennett David’s site on how to choose the best Medicare Plan for your needs.