Medicare is a federally funded health insurance program that provides medical coverage for people over 65 years old, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS).
The health program has been instrumental in providing healthcare coverage to millions of Americans since then. In this article, we will explain everything you need to know about the program.
What Does Medicare Cover?
Medicare is broadly divided into four parts: A, B, C, and D.
Part A: Hospital Insurance
Part A falls under original Medicare, and it is also known as hospital insurance, which covers hospital stays, hospice care, and limited nursing home care.
Part A is usually available to those who have paid into Social Security for at least 10 years. However, those who have not worked enough to earn Social Security credits may still be eligible for Part A through a spouse’s or ex-spouse’s work history.
Most people do not have to pay a premium for Part A because they have paid Medicare taxes while working. However, there are some costs associated with Part A, such as deductibles and copayments. Read more about Medicare Part A here.
Part B: Medical Insurance
Part B also falls under original Medicare, and it is known as medical insurance that covers doctor visits, outpatient services, and medical equipment.
Unlike Part A, Part B is optional and requires a monthly premium. Part B covers a variety of services, including preventive care, diagnostic tests, and medically necessary services.
Most people do pay a premium for Part B, which is based on their income. In addition, there are deductibles and coinsurance costs associated with Part B. Learn more about Medicare Part B here.
Part C: Medicare Advantage Plans
Part C is generally known as Medicare Advantage and is an alternative to Original Medicare. Part C plans are offered by private insurance companies that are contracted with Medicare to provide Part A and Part B coverage.
Part C plans often provide additional benefits, such as vision, dental, and prescription drug coverage.
While it may have lower out-of-pocket costs than Original Medicare, you will likely be limited in your choice of healthcare providers. Read more on Medicare Advantage here.
Part D: Prescription Drug Coverage
Part D is prescription drug coverage that is offered by private insurance companies. It helps cover the cost of prescription medications that are not covered under Part A or Part B.
Medigap: Supplemental Insurance
Medigap policies are supplemental insurance policies that are primarily designed to help cover the costs that are not covered by Original Medicare.
These policies are offered by private insurance companies and are designed to work alongside Original Medicare. Medigap policies may cover things like copayments, coinsurance, and deductibles. Learn more here.
In order to be eligible for Medicare, you must satisfy the following criteria:
- 65 years or older
- A U.S. citizen or permanent resident who has lived in the U.S. for at least five years
- Eligible for Social Security or Railroad Retirement benefits, or have worked long enough to be eligible for these benefits but have not yet filed for them
- Under 65 years old with certain disabilities, such as End-Stage Renal Disease or Amyotrophic Lateral Sclerosis
Most people are automatically enrolled in Medicare when they turn 65 and are receiving Social Security or Railroad Retirement benefits.
If you are not receiving these benefits, you will need to enroll in Medicare during your Initial Enrollment Period (IEP), which is the seven-month period that begins three months before the month you turn 65 and ends three months after the month you turn 65.
If you miss the Initial Enrollment Period, you can enroll during the General Enrollment Period, which occurs annually from January 1 to March 31. However, late enrollment may result in higher premiums.
It is instructive to note that the costs for original Medicare is quite different from medicare advantage. The latter is more expensive because it is offered by private insurance companies.
Choosing the ideal Medicare plan depends largely on your income and health conditions. And that is why you need an upright independent insurance broker to guide you.
At MedicareOnVideo, we are an independent insurance broker offering authoritative medicare advice under the auspices of HealthPlan65.
If you are still unclear about what Medicare entails, we recommend you watch the Video series on “Understanding Medicare – All You Need to Know!”
You can contact us directly at 1-877-855-3484. To know about the A-Z of Medicare, get our Medicare ebook – Medicare Made CLEAR, which contains up-to-date information about all Medicare areas of coverage.