Medicare is a government-sponsored health insurance program that subsidizes the cost of healthcare services in the United States. The program is meant for young people who meet specific requirements, those aged 65 or above and people with certain medical conditions.
Medicare is categorized into different plans covering a wide range of health solutions, some of which are paid for by insured persons. Although the objective of the program is to provide consumers with many options in terms of coverage and costs, it comes with stringent rules for those who wish to sign up.
How Does Medicare Work?
Medicare was created by the U.S Congress as part of the 1965 Social Security amendment Act designed to offer coverage to people aged 65 and more who didn’t have any insurance. The program is currently being implemented by the Centres for Medicare and Medicaid Services (CMS). It also extends coverage to individuals with a disability and those with specific underlying medical conditions.
There are 4 different parts of Medicare and each one of them offers specific types of services to the insured persons. The four parts include:
• Medicare Part A
• Medicare Part B
• Medicare Part C
• Medicare Part D
Who is Eligible for Medicare?
Generally, U.S. citizens or those who have stayed in the country for at least five years are eligible for Medicare Part A once they attain 65 years of age. You will automatically be enrolled into Part A of the program by the government as soon as you reach 65 years of age free of charge as long as you are earning Social Security or Railroad Retirement benefits.
In case you are already getting the Railroad or Social Security Retirement benefits, you just need to check your email for your Medicare Card. It should automatically arrive in your email inbox approximately three months before your 65th birthday. If you are becoming eligible for Medicare because of disability instead of age, then you can expect the Medicaid card for the 25th month of disability. To learn a difference between Medicare vs Medicaid visit this page.
The card will come with the option of pot-out of Part B. However, opting out of part B is only advisable if are still working and enjoying employer-sponsored coverage that provides similar or better coverage.
But if you are not getting Social Security or Railroad benefits, then you will have to register in Medicare within the seven-month open enrolment window. This includes the first three months before you attained the age of 65 years – your benefits will begin the month you turn 65 years. In case you register three months after turning 65 years, your coverage is likely to delay.
Other than the 65-year eligibility requirement, people can also be admitted to the Medicare program as a result of their disability or due to amyotrophic lateral sclerosis or end-stage renal disease (ESRD). Individuals with ESRD become eligible for the program in the fourth month of dialysis treatment in case they participate in the home-dialysis training.
Individuals with ALS get admitted to the Medicare program the same month or time they start receiving their disability benefits.
A majority of people don’t have to remit premiums for Medicare Part A. One qualifies for Part A coverage premium-free on the following conditions.
• If you are 65 years, your current or former partner has remitted Medicare taxes for at least 10 years
• You haven’t attained the age of 65 but you’re disabled and your partner has been paying Medicare taxes for the past 10 years. After getting your Social Security or Railroad Retirement Board disability benefits for at least two years, you will qualify for Medicare with no premiums for Part A.
But if you or your spouse haven’t been paying Medicare taxes for a minimum of 10 years, you will still qualify to purchase Part A coverage. You will however be required to pay a premium. The premium will depend on your work history.
Who is Eligible for Medicare Part B?
When you’re notified about your eligibility for Medicare Part A, you will at the same time receive a notification of eligibility for Part B coverage. Part B is optional and attracts a premium for those who wish to enroll.
Part B will cost you $170.10 per month for most people enrolling in 2022. But it is important to note that Part B costs more for individuals earning more than $91,000 or $182 for those who are married. It is always good to keep checking these figures from time to time since they can change due to inflation and other factors.
It is advisable to enroll in both Part B and Part A. There’s an enrolment window that is open for seven months. Although you can wait three months before turning 65, you should try to enroll early for Part B. If you wait too long, then you might end up clocked out of Part B and forced to wait till the next cycle of Medicare enrolment.
How to Qualify for Medicare Advantage
For you to become eligible for Medicare benefits, you must choose how you will be receiving them. There are two main options: The original Medicare program run by the federal government or through Medicare Advantage. Most Medicare beneficiaries use the Original Medicare but four in 10 are registered with Medicare Advantage.
You must have both Medicare Part A and B to qualify for Medicare Advantage. You can decide which plan to use during the time of enrolment. Most Medicare Advantage plans also entail Part D prescriptions drug coverage.
In general, Medicare is a government health insurance program designed to reduce the cost of healthcare services in the country. The program covers individuals aged 65 and above, young people with particular eligibility criteria and people suffering from certain diseases.
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