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About Medicare and it's eligibility

Medicare is a federal or government-provided health insurance program that began to provide benefits to people roughly 60 years ago. The original Medicare included Part A (hospital insurance) and Part B (medical insurance). Today, these two parts are known as "Original Medicare."

Since its introduction, the government made several changes to include more people in the Medicare database. For instance, they started including: 

• Younger people with disabilities.
• People aged 65 years or older.
• People with ESRD or End-Stage Renal Disease (a condition that leads to permanent kidney failure and requires dialysis or a transplant).

Over the years, more benefits, such as prescription drug coverage, were also offered under Medicare.

You may be confused between Medicare and Medicaid. Medicaid is also a state—and federal-funded insurance program but for individuals with low incomes. Patients can be eligible for both Medicaid and Medicare. 

Introducing the parts of Medicare

Medicare has several parts that cover different types of services. The coverage depends on Medicare's national coverage decisions, federal and state laws, and local coverage decisions the companies make in every state that processes Medicare claims. 

The different parts of Medicare are: 

• Medicare Part A: Part A generally includes inpatient care in a hospital facility, home health care, and care in a nursing facility. A patient or spouse who has paid their Social Security taxes while working for a particular period does not have to pay a monthly premium for Part A. If you are not eligible for the "premium-free Part A," you can buy Part A.
• Medicare Part B: Part B includes durable medical equipment, ambulance services, mental health (inpatient, outpatient, intensive outpatient program services, partial hospitalization), and limited outpatient prescription drugs. It also includes medically necessary services or supplies and preventive services like detecting disease early, when treatment is most likely to work best. 
• Medicare Part D: Part D helps pay for medications a provider prescribes. To get this coverage, patients must get a Medicare-approved plan that gives drug coverage (including Medicare drug plans and Medicare Advantage Plans with drug coverage). This coverage includes generic and brand-name medicines as well as vaccines or shots. 

There is also Plan C. Also known as a Medicare private health plan or Medicare Advantage (MA) Plan, these have contracts with the federal government. A fixed amount is paid to provide Medicare benefits.

The most common MA Plan types are:

• Health Maintenance Organizations (HMOs)
• Preferred Provider Organizations (PPOs)
• Private Fee-For-Service (PFFS)

OB-GYN vs. Gynecologist

There is a common misconception regarding the roles of OB-GYNs and gynecologists. An OB-GYN specializes in obstetrics and gynecology, encompassing pregnancy and childbirth care along with gynecological services. On the other hand, a gynecologist focuses specifically on female reproductive health, from the onset of menstruation to post-menopausal care.

Gynecologists are adept at diagnosing and treating a wide range of reproductive-related conditions, including those concerning the cervix, uterus, ovaries, fallopian tubes, and vagina. They also conduct essential screenings such as breast exams, pap smears, and pelvic exams while offering guidance on sexual health and family planning. Additionally, gynecologists can perform procedures like hysterectomies and tubal ligations.

In contrast, obstetricians-gynecologists, or OB-GYNs, specialize in female reproductive health, pregnancy, and childbirth. Some OB-GYNs also provide comprehensive general health services akin to those provided by primary care physicians, including routine check-ups and preventive screenings for gynecologic cancers. They are equipped to diagnose and treat various conditions, such as abnormal bleeding, breast disorders, endometriosis, hormonal imbalances, infertility, pelvic pain, and infections of the urinary tract or vagina.

In summary, a gynecologist can address non-pregnancy-related issues about female reproductive health. However, many physicians choose to specialize in OB-GYN to offer comprehensive care for the full spectrum of their patients' healthcare needs.

What do copayment, deductible, and coinsurance mean?

Health insurance plans often require you to share the costs of coverage in different ways, including copayments, deductibles, and coinsurance. 

• Copayments are a fixed fee you pay for a doctor's visit, prescription refill, or covered service, with your insurer covering the rest. 
• Deductibles are the total amount you must pay for covered medical assistance before insurance coverage kicks in. Generally, plans that come with higher monthly premiums have lower deductibles, and vice versa.
• Coinsurance is the percentage of the cost of covered healthcare services that you pay, typically after your deductible is met, with the rest covered by your insurer. Note that these costs can differ depending on whether you receive services from an in-network or out-of-network provider.

To better understand health insurance-related terminology, visit Zocdoc's Health Insurance 101 for more information.

Find the best ob-gyn doctors that accept Medicare near you.

If you've just started getting your period, are pregnant, or are planning to start a family, an OB-GYN can address all your concerns and provide personalized care. Zocdoc helps you find qualified OB-GYNs based on your needs and preferences. Visit the Zocdoc website, enter your condition or symptoms, location, and insurance plan, then browse and filter for top-rated OB-GYNs.

Further, you can also select your insurance carrier and plan in the drop-down menu at the top of the page to find a list of in-network OB-GYNs. For example, you can specifically search for ob-gyn doctors who accept Medicare near me. Additionally, you can upload your insurance card securely and hassle-free. Zocdoc prioritizes your privacy and security and follows the industry's best practices to safeguard your information. You can read more about how Zocdoc handles data and privacy, and check out Zocdoc's Patient Help Center for answers to any further insurance-related queries.

If you need help determining which health plan is right for you, Zocdoc's insurance checker can assist. If you're interested in purchasing health insurance but need help figuring out where to begin, you can start by reviewing Zocdoc's Health Insurance 101 guide, which covers insurance basics.

Zocdoc also helps you make an informed decision by listing each provider's educational background, including clinical training, certifications, licenses, awards, and accreditations. Another way to choose the best OB-GYN is to read honest and verified patient reviews. 

All bookings on Zocdoc are fast, free, and secure!

Statistics on Medicare healthcare insurance

As of March 2023, the Centers for Medicare & Medicaid Services (CMS) has released the latest enrollment figures for Medicare. There are currently over 65,748,297 people enrolled in Medicare, which shows an increase of almost 100,000 from the last report in September. Out of this total:

• Approximately 33,948,778 are enrolled in Original Medicare (Medicare Part A & B).
• About 31,799,519 are enrolled in Medicare Advantage or other health plans (Medicare Part C), including plans with and without prescription drug coverage.
• Around 51,591,776 are enrolled in Medicare Part D, which includes stand-alone prescription drug plans and Medicare Advantage plans offering prescription drug coverage. 

Sources

Center for Medicare Advocacy

Centers for Medicare & Medicaid Services

Healthline

Medicare[1]

Medicare[2]

Medicare[3]

Medicare Interactive[1]

Medicare Interactive[2]

Medicare Interactive[3]

Wooster Community Hospital

The content herein is provided for general informational purposes only and is not a substitute for professional medical advice, diagnosis or treatment. Medical information changes constantly, and therefore the content on this website should not be assumed to be current, complete or exhaustive. Always seek the advice of your doctor before starting or changing treatment. If you think you may have a medical emergency, please call your doctor or 9-1-1 immediately.