医疗保险的基础

Medicare is the federal government program that provides health care coverage (health insurance) if you are 65+, under 65 and receiving Social Security Disability 保险 (SSDI) for a certain amount of time, 或65岁以下及患有终末期肾病(ESRD). 医疗保险中心 & Medicaid 服务 (CMS) is the federal agency that runs Medicare. The program is funded in part by Social Security and Medicare taxes you pay on your income, 部分是通过医疗保险支付的保费, 部分原因是联邦预算.

一旦你符合医疗保险资格并注册, you can choose to get your Medicare benefits from Original Medicare, the traditional fee-for-service program offered directly through the federal government, 或者从医疗保险优势计划中, a type of private insurance offered by companies that contract with Medicare (the federal government). 原始医疗保险包括:

• 甲部(住院/医院保险)
• B部分(门诊/医疗保险)

If you want Medicare prescription drug coverage (Part D) with Original Medicare, in most cases you will need to actively choose and join a stand-alone Medicare private drug plan (PDP).

You still have Medicare if you enroll in a Medicare Advantage Plan. This means that you will still owe a monthly Part B premium (and your Part A premium, 如果你有的话). Each Medicare Advantage Plan must provide all Part A and Part B services covered by Original Medicare, 但可以用不同的规则, 成本, and restrictions that can affect how and when you receive care. 医疗保险优势计划也可以提供D部分保险. Note that if you have health coverage from a union or current or former employer when you become eligible for Medicare, you may automatically be enrolled in a Medicare Advantage Plan that they sponsor. 你可以选择继续这个计划, 转向原始医疗保险, 或者参加不同的医疗保险优势计划, but you should speak with your employer/union before making any change.

It is important to understand your Medicare coverage choices and to pick your coverage carefully. How you choose to get your benefits and who you get them from can affect your out-of-pocket 成本 and where you can get your care. 例如, 在原始医疗保险中, you are covered to go to nearly all doctors and hospitals in the country. 医疗保险优惠计划, 另一方面, 通常有网络限制, meaning that you will be more limited in your access to doctors and hospitals. 然而, 医疗保险优惠计划 can also provide additional benefits that Original Medicare does not cover, 比如日常的视力或牙齿护理.

医疗保险不同于医疗补助, which is another government program that provides health insurance. Medicaid is funded and run by the federal government in partnership with states to cover people with limited incomes. 取决于国家, Medicaid can be available to people below a certain income level who meet other criteria (e.g., age, disability status, pregnancy) or be available to all people below a certain income level. Remember, unlike Medicaid, Medicare eligibility does not depend on income. Also, eligible individuals can have both Medicare and Medicaid and are known as dual-eligibles.

Everyone who has Medicare receives a red, white, and blue Original Medicare card. If you choose to receive your coverage through Original Medicare, 您办理服务时要出示这张卡. If you choose to receive your Medicare benefits through a Medicare Advantage Plan, you will still get an Original Medicare card but you will show your Medicare Advantage Plan card when you get services. 不管你是如何获得医疗保险福利的, only give your Medicare number to your doctors and health care providers.

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