Medicare is a federal health insurance program that’s available to anyone who is 65 or older. It offers protection against the high costs of hospitalization, doctors’ fees, and other medical expenses for people with limited income and financial resources. What do you need to know about Medicare? This article will answer all your questions!
Who is Eligible for the Medicare?
To be eligible for this insurance cover, you must meet certain requirements. You are eligible automatically if you are 65 or older and either receive Social Security benefits or railroad retirement (RRB) compensation or have been covered by Social Security or the Railroad Retirement Board for at least 10 years.
You can also qualify because of end-stage renal disease (ESRD), amyotrophic lateral sclerosis (ALS), or kidney failure, or permanent kidney transplant. Even if you are under 65, you may be eligible for these insurance benefits if you have been entitled to Social Security disability benefits for at least 24 months, are a veteran with a service-connected disability, live in the U.S., and meet certain requirements. Also, you may be eligible if you are a U.S. citizen living abroad and meet certain requirements, or were a Peace Corps volunteer and have certain diseases that developed during or began after your Peace Corps service.
What are the Medicare Benefits?
- Doctor visits; hospital stays; lab tests, x-rays, and other services to diagnose and treat illnesses; medical equipment, supplies, and medications to treat illnesses or injuries;
- Certain preventive services, including flu shots, diabetes screening tests, PAP smears to test for cervical cancer, mammograms to screen for breast cancer, colonoscopies to screen for colon cancer, and Pap smears for women over 65;
- Other doctor visits when they are needed to treat or manage a chronic illness;
- Physical, occupational, and speech therapy but only for certain problems after an accident or if you have a condition caused by stroke, Parkinson’s disease, ALS, cerebral palsy, or muscular dystrophy;
- Some home health services are related to your treatment plan.
What are the Costs of Original Medicare?
Original Medicare is a government-run health insurance program. It doesn’t require a monthly premium, but you must pay a deductible before your medical costs are covered by Original Medicare. The deductible changes each year and varies depending on whether you receive care in the hospital or doctors’ offices. Any additional fees are also up to you. With the Original coverage, you can choose your own doctor or hospital when seeking medical care.
Original coverage gives you the freedom to be your own health care manager. It does require some effort on your part to learn about and compare costs and services offered by various providers in your area. It also requires you to cover monthly premiums, deductibles, co-insurance, and co-pays for certain medical services.
What are Parts of Medicare?
There are four different parts or “tiers” to this cover. You may be in only one of the tiers, depending on your situation and whether you want Original cover (Parts A&B) or a Medicare Advantage Plan (Part C). You can learn more about available Medicare plans in your state on the websites like ClearMatch Medicare, Medicare.gov, or others.
Here’s a description of each tier:
Part A (Hospital Insurance)
This is available without a monthly premium if you have worked and paid Social Security taxes for at least ten years or have been married to someone who has. You must pay a monthly premium if you haven’t paid into the system that long or aren’t eligible because of your spouse’s work record. In addition to covering most inpatient hospital services, Part A also covers hospice care, home health services, and a limited number of skilled nursing facility stays.
Part B (Medical Insurance)
You must pay a monthly premium for Part B coverage. The premium is adjusted each year on a sliding scale based on your income. What you pay depends on your tax filing status and modified adjusted gross income (MAGI). If you don’t pay the premium, you lose your Part B coverage.
Part A and Part B provide similar benefits, but Part A is primarily for inpatient care while Part B focuses on income-generating outpatient services.
Part C (Advantage Plan)
If you don’t want Original cover or already have other insurance, you may choose to get your benefits through a health maintenance organization (HMO) under Part C. Under this option, private companies offer plans that provide all of your Part A and B benefits except hospice care, which isn’t covered by Part C. Different plans offer different benefits at different costs.
Part D (Prescription Drug Coverage)
This optional plan is offered through private companies approved by this cover. The monthly premium varies depending on your specific plan, and coverage may also include the costs of certain medical supplies not covered by Part B. There is also a deductible and coinsurance costs, which are sometimes waived if you choose a “stand-alone” drug plan.
Part D plans are developed by private plans approved by this cover to provide prescription drug coverage for those who want it but don’t have it through an employer or other group health plan. There are stand-alone Prescription Drug Plans (PDPs) and Medicare Advantage Prescription Drug plans (MAPDs). The latter are offered through the same organizations that provide Medicare Advantage Plans.
Original coverage is the only program that allows patients to utilize both inpatient and outpatient benefits in less than one insurance plan. This makes it beneficial for those with complex healthcare needs, allowing them to explore their options more fully without paying expensive additional costs charged by private companies.
As long as you are willing to do some research about your doctor or hospital beforehand, the freedom to choose your doctor, see whoever you want, and have insurance coverage for check-ups makes Original Medicaid an ideal choice.