Medicare

Medicare offers affordable health care to seniors 65 years of age or older. Medicare insurance also provides coverage to individuals with specific disabilities who qualify for this government benefit.

During a Medicare enrollment period, individuals may select from a variety of plans depending on their needs. Medicare Part A is free to most beneficiaries. However, the remaining plans carry premiums. Additionally, beneficiary’s must pay deductibles and coinsurance along with their premiums.

To qualify for Medicare, individuals must be 65 years of age or have end stage renal disease (ESRD) or amyotrophic lateral disease (ALS). Persons may also qualify if they begin receiving Social Security or Railroad Retirement Board benefits. These individuals automatically qualify for the program and do not need to apply. However, those who do not qualify automatically must apply for their coverage. To sign up for Medicare, applicants must visit the Medicare website and submit their information. Potential beneficiaries can read the sections below for more Medicare information, what Medicare benefits cover and how much the insurance costs.

What is Medicare?

Medicare health insurance is the federal health care plan for seniors and some disabled individuals. Medicare insurance provides affordable coverage for inpatient care, medical services and prescription drugs. Individuals may select one or more of the following plans when they apply for Medicare:

  • Medicare Part A – Hospital coverage
  • Medicare Part B – Medical services
  • Medicare Part C – Comprehensive insurance
  • Medicare Part D – Prescription drugs
  • Medigap – Gap insurance

Related Article: Medicare Costs and Coverage

Which plan an individual select depends on their medical needs, their age and whether they have an existing insurance plan. Beneficiaries aren’t limited to Medicare coverage for their healthcare. The plan coordinates with a beneficiary’s other insurance coverage, including Medicaid, to pay the individual’s medical bills.

Medicare Eligibility Requirements

Medicare eligibility depends mostly on age. Individuals must be 65 years of age or older to meet eligibility requirements. Applicants younger than 65 years of age may qualify if they:

  • Are receiving Social Security Disability Benefits for 24 months.
  • Are receiving Railroad Retirement Benefits for 24 months.
  • Have end stage renal disease board (ESRD).
  • Have amyotrophic lateral sclerosis (ALS).

A beneficiary must also have the required number of work credits to meet Medicare qualifications. Individuals earn work credits for each year of work based on their earnings. They may receive up to 4 credits per year. To qualify for the program, applicants must have 40 credits, which equates to 10 years of work.

Applicants may meet Medicare eligibility requirements if their spouse receives Social Security or Railroad Retirement Board disability benefits. They may also qualify if they are the dependent of a parent of a fully insured deceased child.

What do Medicare benefits cover?

Medicare coverage pays most of a beneficiary’s medical bills depending on the plan selected during enrollment. Individuals may choose one or more of the following Medicare insurance options to get the health care they require:

Medicare Part A

Through Part A, beneficiaries receive coverage for inpatient hospital stays. They also receive coverage for some skilled nursing care as well as in-home services such as physical therapy or occupational therapy.

Medicare Part B

Coverage under Part B provides the medical care insurance an individual requires. Specifically, Part B pays for primary care visits and preventive care such as health screenings.

Medicare Part D

Beneficiaries may elect prescription drug coverage under Part D. With this plan, beneficiary’s receive help paying for their medications.

Medicare Advantage

Those who do not wish to enroll in original Medicare may opt for a Medicare Advantage plan. The Advantage plans are offered through a third-party company contracted by Medicare to provide the coverage. If a person purchases an Advantage plan, they receive their Part A and Part B coverage in one plan. Some plans also include Part D coverage.

Medigap

Although Medicare pays most of a person’s medical bills, it does not pay in full. As a result, beneficiary’s may be required to pay out-of-pocket for the remaining balance. Individuals may purchase Medigap insurance to help minimize their out-of-pocket costs. Those individuals who have Medicaid may not need to buy Medigap. They should verify if the plan helps with out-of-pocket costs before signing up for Medigap.

How much does Medicare cost?

Part A is a required Medicare coverage for those who qualify. All other plans are optional Medicare coverages. Part A is free to most beneficiaries. However, if a person does not have enough work credits, they must pay a premium for their coverage. All beneficiaries must pay a premium for all other Medicare coverage options.

Those who must pay a premium for their Part A must pay $422 or $232 depending on how many work credits they have earned. Part B coverage costs $134. However, the amount may be higher depending on a beneficiary’s income. Medicare Parts C, D, Medicare Advantage and Medigap are plans managed by third-party companies. Given that, plan prices vary between each insurance company. Beneficiaries may get full details on costs by contacting the insurance companies directly.

Besides premiums, beneficiaries must pay deductibles and coinsurance for their Medicare coverage. The deductible represents the amount a person must pay for their services before coverage begins. A coinsurance represents the amount of out-of-pocket expenses that an individual must care for each service. In some cases, beneficiaries may be dual eligible for both Medicare and Medicaid. In those instances, Medicaid may pay the beneficiary’s insurance premiums and may help cover some of the out-of-pocket costs for each service.

Those with an existing health insurance plan may enroll in Medicare , but the two companies split the patient’s bills. Those with current coverage through an employer plan may elect to drop Part B or delay Part B. However, the rules for dropping coverage is very specific, and an individual could face fines for delaying Part B coverage when they qualify. Also, if a beneficiary drops coverage without verifying if they may do so without penalties, could experience a gap in their health coverage.

How to Sign Up for Medicare

There are two ways for individuals to sign up for Medicare insurance. In some cases, a person qualifies for automatic enrollment in Medicare Part A and Part B. Specifically, those who begin receiving Social Security and Retirement Railroad Board disability benefits at least four months before turning 65 years of age.

Those who do not qualify for automatic enrollment must enroll during their open enrollment period. If applicants do not register during their enrollment period, they may be required to pay a late enrollment fee for Part B. Also, if they do not sign up during their enrollment period, they must wait until the next open enrollment. However, if an individual meets the criteria for what is known as a “special event,” they may select coverage outside of their enrollment period without facing penalties.

Individuals may apply for Medicare by visiting the plan website. They must create an account and login to begin their application. When applying for Medicare insurance, they must provide information such as their full name, Social Security Number and employment information.

If a beneficiary wishes to receive insurance through a Medicare Advantage plan, they must first select a suitable plan. They may locate plans by using the plan locator tool on the Medicare website. Individuals may locate and choose a Medigap plan in the same manner.

Once a person’s insurance coverage begins, there is no requirement to renew. In some cases, beneficiaries under an Advantage Plan, Medigap or Part D plan must elect a new plan if their insurance company makes changes to or drops the beneficiaries existing plan.

Related Article: Eligibility Requirements for Medicare

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