Today, most people have heard of Medicare, but it can be hard to discern exactly what it is, how it works and who is eligible. All that information will be provided in this article, but let’s start with how it works.
Medicare is a government program that provides certain people – mostly those 65 years of age or older – with health insurance coverage through either Original Medicare or Medicare Advantage. Original Medicare is run by the federal government, while Medicare Advantage is administered through private insurance companies that have received approval from the Medicare program.
Every plan under Medicare has its own cost and coverage standards, but there is a standard level that has been set by Medicare. Every Medicare plan must at least meet those standards, though some will go above and beyond those services at various different costs and monthly premiums.
Below you will find more information about who is eligible to receive Medicare, what the different parts and plans specifically cover and how and when you should apply if you are eligible. Medicare can seem intimidating at first due to all the different parts and options, but it does not have to be. Understanding Medicare will help ensure that you get all the benefits that you are qualified to receive.
Who Is Eligible for Medicare?
You will have to meet different criteria in order to qualify for different parts of Medicare. Generally, however, if you are 65 years of age or older, you may qualify for at least some Medicare benefits.
Citizens or permanent residents of the U.S. who are 65 years of age or older can get Medicare Part A (hospital insurance). You will not have to pay for Part A if you meet one of the following conditions:
- You are receiving or qualify for Social Security or Railroad Retirement benefits.
- Your spouse (living or deceased) is receiving or qualifies for Social Security or Railroad Retirement benefits.
- You or your spouse is a government employee or retiree who has paid Medicare payroll taxes while working.
Others will have to pay a premium.
If you are younger than 65 years of age, you can get Medicare Part A at no cost if you meet certain conditions. These conditions include, but are not limited to, the following:
- You have been receiving or have been qualified for Social Security disability benefits for at least 24 cumulative months.
- The Railroad Retirement Board gives you a disability pension.
- You receive Social Security Disability benefits because you have Lou Gehrig’s disease.
- you have permanent kidney failure, and you require regular dialysis or a transplant.
Those eligible for Part A can choose to enroll in Part B (Medical Insurance).
If you have Parts A and B (government-run Medicare), you can choose to enroll instead in Part C (Medicare Advantage plan from a private insurance company). Alternatively, if you have Parts A and B, you can choose to enroll in Medicare Part D (prescription drug coverage).
The last section of this article provides more details on the different Parts of Medicare.
How Do You Enroll in Medicare?
If you are already receiving retirement benefits from the Railroad Retirement Board or Social Security, then you will automatically start getting Medicare the month you turn 65. However, others may need to apply.
The Medicare program recommends applying for Medicare benefits three months before you turn 65. Your enrollment period runs from three months before your 65th birthday up until three months after your birthday. If you choose to enroll later, you can do so from January 1 to March 31 each year.
You can apply online for Medicare Parts A and B through the Social Security Administration (SSA) website.
You will avoid having to pay a penalty if you sign up for Medicare Part B when you first become eligible, rather than later on. If you do not enroll in Part B during your enrollment period but choose to sign up later, you may have a higher premium.
Once you have Part A and/or Part B, you can use the Medicare Plan Finder online to find a Medicare Advantage plan or a Medicare Part D drug plan. Once you have found a plan, you can apply through the insurance company online, by mail or by phone.
What Does the Program Cover?
Medicare Part A is hospital insurance. This part covers things like skilled nursing facility care, hospice care, home health care and inpatient care at a hospital. For many people, Part A is free as long as you (or a spouse) has worked for a certain amount of time and paid Medicare taxes. If you do not meet those requirements, you can still receive Medicare Part A, but you will have to pay a premium.
You are able to use Part A Medicare, along with Part B, at any medical provider that you want as long as they are willing to take Medicare.
Medicare Part B (medical insurance) expands on your options from Part A. It covers things like durable medical equipment, services provided by medical professionals, outpatient care and a variety of preventative services. If you are interested in Medicare Part B, it is recommended that you sign up for it the first time you have the opportunity to do so, as you will most likely have to pay a penalty when you try to sign up later on. You will have to pay a monthly premium with Part B.
Medicare Part C is a version of medicare that is offered by private insurance companies, but they have to be approved by Medicare to do so. Part C will include all of the benefits provided under Part A and Part B, but most insurance companies will also offer you prescription drug coverage, which is covered under Medicare part D.
You may even find companies that offer dental and vision insurance. With Medicare Part C, you will have an approved list of medical providers, doctors and hospitals that you will have to go to.
As stated above, Medicare Part D is the part of Medicare that covers prescription drugs. If you choose to get Part D, Medicare will help you pay for the cost of your prescribed medications.