Medicare is managed federal social insurance program which provides medical health insurance protection for the elderly and persons with certain disabilities. Medicare is funded jointly by the federal government and middle-income households through payroll taxes. It provides coverage for inpatient hospitals, skilled care amenities, hospice and home health care, and other medical services. The program is funded primarily through payroll taxes paid by workers and employers.
Requirements to Qualify For Medicare Benefits
• – You must be at least 65 years old on the day before the first day of the first month of your retirement, otherwise you must be retired and reach the age of 65 in one month in which you are eligible to receive retirement benefits under Social Security.
• – You must be disabled as specified by Social Security Administration policy. Your disability must also meet the definition used by your employer’s private insurance company or the Railroad Retirement Agency.
• – You must be a US citizen or foreign permanent resident with a green card, living in the United States and not living in an establishment such as a hospital or nursing home. Individuals without this status may qualify for Medicare if they’ve legally lived in the United States for five consecutive years or more (the “5 year rule”), are disabled, have end-stage kidney disease, or have ALS.
• – You must have the same Medicare-eligible medical conditions that are covered under either employer-sponsored coverage or coverage under Social Security. If you take part in a group health plan, you must have the same health problems that protect you from being fired from your job.
• – You must pay Medicare payroll taxes for at least ten years. Individuals under the age of 65 who don’t have the required ten years of cover may still be covered under strictly limited conditions.
• – You must purchase Medicare Part B Medical Insurance irrespective of your age, health status or medical condition. If someone qualifies for premium-free Part A, they will not have the ability to buy Part B either.
Types of Medicare Plans
1. Medicare Part A – Hospital Cover
Medicare Part A is the most common and basic type of Medicare coverage. This includes hospitalization in inpatient hospital amenities, skilled care amenities, hospice care, home health care, and ambulance services. Part A also covers a limited number of lasting medical equipment and supplies (DME), such as wheelchairs, walkers, and hospital beds, for use in your home. Medicare Part A is available to individuals who are 65 years of age or older, have a permanent disability, or are eligible for Social Security Disability Insurance (SSDI) benefits.
2. Medicare Part B – Health Insurance
Part B covers a broad range of medical services and supplies, including physician services, home health care, and outpatient services in hospitals. Medicare Part B also pays for a limited amount of DME at home. For most people, Part B premiums are deducted from their Social Security income or benefits if they qualify or have earned them Social Security Disability Insurance (SSDI) benefits if they don’t qualify for Part A. Medicare Part B is available to everybody aged 65 years or older and certain individuals under the age of 65 with certain medical conditions.
3. Medicare Advantage Plan (Medicare Part C)
Medicare Advantage plans are health plans that offer coverage similar to the types of benefits provided under Parts A and B of Original Medicare. However, there may be different rules for eligibility and benefits, which you should review carefully before signing up for a plan. These plans may have additional benefits that traditional Medicare does not. You should also remember that Medicare Advantage Plans (Part C) normally have higher out-of-pocket costs than Original Medicare.
4. Prescription Drug Coverage (Medicare Part D)
Medicare Part D covers most prescribed drugs but has an annual deduction and there may be other fees you’ll have to pay when your prescription is filled at the pharmacy. There are many various Medicare Prescription Drug Plans (Part D) you can select from, and you can enroll in a prescription drug plan on its own or together with your preferred Medicare Advantage (Part C) plan.
Advantages of Having a Medicare Plan
1. Access to Private Health Insurance
If you have a private medical health insurance policy that covers you and your family, you may choose to keep it. However, let’s say you enrolled in a Medicare Advantage plan (Part C). In this case, your current medical health insurance may not cover the difference between coverage under Original Medicare (Parts A & B) and plan benefits.
2. Additional Benefits
Medicare Advantage plans (Part C) often provide additional benefits that aren’t available under Original Medicare (Parts A & B). This may include vision and dental coverage, healthcare, and prescription medicine.
3. Lower Out-of-Pocket Costs
Medicare Advantage plans may have lower out-of-pocket costs than Original Medicare (Parts A & B). However, you should carefully compare the costs of the two options to determine which is more cost-effective.
4. Additional Medicare Entitlements
If you are enrolled in Medicare Advantage (Part C) or a stand-alone prescription drug plan, you have additional rights, such as signing up for retroactive drug coverage when you get a new prescription. This means that any expenses incurred after your last Part D enrollment date are covered retroactively. However, if you aren’t enrolled in a plan, there isn’t any automatic right to receive retroactive coverage. You may must contact your insurance company and request this benefit.
5. Prescription Drug Discount Card
Some Medicare Advantage (Part C) plans offer discounted prescribed drugs for applicants. However, some packages don’t provide this discount because they don’t want to pay the administrative and other fees related to offering these benefits. However, if your plan offers these benefits, you may qualify for discounted prescribed drugs at thousands of participating pharmacies nationwide.
Disadvantages of Having a Medicare Plan
1. Deductibles and Coinsurance
Medicare Advantage (Part C) plans normally have a deductible and coinsurance, meaning you must pay a certain quantity out of your pocket before the plan pays anything for your medical expenses. In addition, you’ll normally incur higher costs if you receive prescribed drugs from a Medicare plan than if you get them through private insurance.
2. Access to Covered Services
If you are enrolled in a Medicare Advantage plan (Part C), that plan’s network of doctors and hospitals may not include many providers. This can cause problems when trying to schedule necessary maintenance and diagnostic services.
3. Off-Network Coverage
Receive your medical services from providers outside the network. Your Medicare Advantage plan (Part C) may pay nothing until you pay a more good portion of the bill. You may must pay the whole cost out of pocket.
It is in your best interest to discuss the benefits, costs, and alternatives to Traditional Medicare (Parts A & B) with your doctor and other healthcare professionals before enrolling in any Medicare plan. This can make sure that you have the mandatory medical protection for your family should you need it in an emergency.