Medicare is a federal government healthcare program that was first introduced in 1965. Since that time it has become a crucial component of the American healthcare system. Those 65 and older, as well as younger persons with certain disabilities and chronic conditions, can use the insurance program to get the treatment they need without worrying about outrageous prices. This program has various parts, including Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drug coverage). Ultimately, it can be a great alternative to health insurance for those who meet certain qualifying requirements.
Eligibility for Medicare
To be eligible for Medicare, you must meet the following criteria:
- You must be at least 65 years old or have a qualifying disability or medical condition.
- Citizenship: You have to be a U.S. citizen or green card holder for at least five years.
- Employment history: You or your spouse must have worked for at least ten years and paid Medicare taxes.
- ESRD (end-stage renal disease): If you have ESRD, regardless of your age, you may be eligible for the program.
It is crucial to remember that eligibility requirements may differ based on the individual component of the program’s part you are looking to apply for.
Also, certain people may be eligible for the program according to other special circumstances, such as having Lou Gehrig’s illness or receiving Social Security Disability Insurance for a certain amount of time.
What are the Parts of Medicare?
Medicare is divided into several parts, each of which covers different aspects of healthcare:
Medicare Part A – This part of Medicare covers inpatient hospital care, skilled nursing care, and hospice care. It also covers some home health care services. To be eligible for Part A, you must have worked and paid Social Security taxes for at least 10 years. If you meet this requirement, you typically will not have to pay a premium for Part A.
Medicare Part B – This part covers doctor visits, outpatient care, preventative services, and medical equipment.
It is optional, and you must pay a monthly premium to enroll. The premium amount depends on your income. Part B also has an annual deductible, which is the amount you must pay out of pocket before a plan begins to cover your expenses.
Medicare Part C – This is an alternative to traditional Medicare and is provided by private insurance companies. To enroll in a Medicare Advantage plan, you must first be enrolled in both Part A and Part B. Medicare Advantage plans provide all the benefits of Medicare Part A and B, which may include additional benefits, such as dental, hearing coverage, and vision coverage.
You must still pay your Part B premium, along with any premium that your Advantage plan may charge.
Medicare Part D – This section covers prescription medications. It is optional as a Part B and has monthly premiums. When you become eligible for the program, you can enroll in a Part D plan, or you can join during the open enrollment period. A formulary of covered drugs is provided by each Part D plan. You should review the formulary before enrolling in a plan to ensure it covers the medications you need.
Medigap: Supplemental Insurance
Original Medicare (Parts A and B) does not cover all medical expenses. Medigap is a supplemental insurance policy that can help cover some of the costs that Medicare does not pay for. These policies are sold by private insurance companies, specified with letter codes, with each plan offering a unique benefit set. You should remember that you can only use Medigap policies to supplement the original parts of the program, as they cannot be used in combination with Advantage plans. Some Medigap policies cover copayments, coinsurance, and deductibles, while others offer additional benefits such as foreign travel emergency coverage.
How to choose the Medicare plan?
If you’re new to the system or have unique health needs, enrolling in Medicare can be overwhelming. However, working with an experienced insurance broker can provide you with a customized approach and simplify the enrollment process. At Baker Consulting, we can help you find the most cost-effective plans and guide you through the enrollment process. We can also assist you in finding temporary insurance coverage as a bridge to cover the gap between leaving a job and enrolling in the healthcare program or waiting for the Medicare enrollment period to begin.
Contact us today to explore your options and find the coverage that meets your needs.