What is Medicare Insurance?
Turning 65? As you age Medicare will play a major role in your healthcare for the rest of your life. Medicare is a federal health insurance program in the U.S. This was originally designed to provide coverage for retirees over the age of 65. The Medicare insurance coverage has been advanced to include people younger than 65 with certain illnesses and disabilities. The Medicare program supports people with the cost of health care, which can be daunting. However, it might not cover all medical expenses or the cost of most long-term care.
Who is Eligible for Medicare Insurance?
Traditional Medicare has constantly played a vital role in providing health coverage for people aged 65 and older. The traditional Medicare allows people to pay for a wide range of services, including hospitalizations, physician visits, preventive services, and hospice care.
The original Medicare has various benefits in the form of Medicare Advantage (MA) plans, including:
Plenty to offer,
A market for high-performing,
Quality private health plans have emerged,
Giving insurers an incentive to provide optimal,
Reasonably priced coverage.
To enroll in Medicare, you must satisfy specific conditions, such as:
Citizenship or residence status: Your citizenship status is the first aspect of Medicare insurance eligibility. To be eligible for Medicare Insurance you must be a U.S. citizen or a permanent legal resident. For being a permanent legal resident, you must live in the United States for at least five consecutive years.
Age, health, or disability: In case you meet the citizenship or residence status you can enroll in Medicare once you meet one of the following entry requirements:
Age 65 or older
If under age 65, but have received disability payments from Social Security for 24 consecutive months or payments from the Railroad Retirement Board.
If under age 65 and diagnosed with end-stage renal disease (ESRD).
If under age 65 and diagnosed with amyotrophic lateral sclerosis (ALS), or Lou Gehrig’s disease.
How Does Medicare Insurance Work?
In the United States Medicare meets the needs of more than 60 million Americans. The basic program of Medicare is known as Original Medicare, which is the coverage you receive if you sign up for the program at a Social Security office or online at the Social Security Administration’s website.
Original Medicare provides two types of insurance benefits that include:
Part A or Hospital Coverage: This part provides institutional benefits that include the services including:
Inpatient hospital visits
Skilled nursing care
If you have worked for 10 or more years you do not pay a premium for Part A and it was part of benefits during your working career and your employer paid Medicare tax on your behalf.
If you did not work long enough to qualify for premium-free Part A, you may still qualify if you are, or were, married to someone who did. You can pay a monthly premium if you do not qualify for the above criteria through work history or marriage.
This part is your hospital insurance that pays toward hospital expenses, hospice care, skilled nursing facility stays, rehabilitation facility stays, and even some of the home healthcare services. This is incorrect to assume part A might pay everything in the long haul. Rules of Medicare are strict that limit how long it will cover these services, if at all.
Part B or Medical Coverage: Part B of Original Medicare includes benefits for outpatient medical services. It covers services and procedures such as:
Therapy visits (physical, occupational).
Diagnostic testing, including lab work, X-rays, and magnetic resonance imaging (MRI).
Certain cancer treatments, such as chemotherapy.
Part B coverage has to be paid by a monthly premium that goes to the federal government.
Part B of the Original Medicare is your medical insurance that covers a variety of medical services, such as:
Healthcare provider visits,
Preventive screening tests (e.g., for cancer and heart disease),
Durable medical equipment,
Wellness visits, and more.
Although the above services are technically provided at a hospital, Medicare does not consider it under hospital care unless you are admitted as an inpatient.
Part C or Medicare Advantage: This is referred to as Medicare along with Choice, which is an alternative to Original Medicare. You have a choice between Original Medicare (Parts A and B) and Part C, but the government does not allow both.
Private companies offer Medicare Advantage plans under signed contracts with the federal government. These plans would cover everything Original Medicare does along with additional services called supplemental benefits.
Sometimes, the Americans choose Medicare Advantage plans over Original Medicare to make sure they had extended coverage for the services they needed including dental, hearing, vision. Medicare Advantage plans have an added cost to beneficiaries, who usually pay higher monthly premiums than they would on Original Medicare.
Part D or Prescription Drug Coverage: This includes prescription drug coverage that was signed into law in 2003 under President George W. Bush and took effect in 2006. These plans are run by private insurance companies, but they must meet standard guidelines set forth by the federal government.
Each Medicare beneficiary must decide which plan best fits their needs as no one plan covers all medications. Each plan has a different medication formulary.
When should one Enroll in Medicare?
The First Enrollment Period for Medicare starts three months before and ends three months after your 65th birthday. In case you are on Social Security Disability Insurance (SSDI) you become eligible for Medicare in the 25th month of SSDI benefits. You are automatically enrolled in the program by the Social Security Administration. You may be eligible for special enrollment periods based on your employment history or other health insurance coverage they have.
You can change your Medicare coverage plan during the Open Enrollment Period every year. You can change from one private Medicare plan to another, or change from Original Medicare to Medicare Advantage (or vice versa during this period.
Medicare is a complicated program with ever-changing rules and regulations and may get tricky to know how to proceed.
Under Medicare original and Medicare advantage, each plan can vary in cost and specific drugs covered but must give at least a standard level of coverage set by Medicare. The drug coverage under Medicare includes generic and brand-name drugs. Medicare provides financial protection in case you have a serious accident or illness.
If you or anyone you know needs information about Medicare Insurance, our expert providers at ASP Cares will take care of your health and help you recover.
Call us on (210)-417-4567 to book an appointment with our specialists.