Understanding Medicare Benefits

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Understanding Medicare Benefits

Understanding Medicare benefits can seem impossible. There are four different parts to this program, and eligibility varies based on which part you are interested in obtaining. In many cases, you must be at least 65 years of age to enroll, but you may qualify early if you have a particular medical condition. Some programs are only available based on your address. Whether or not you have to pay, and how much, depends on your income level and what part of the program you are utilizing. There is a lot to learn.

Researching the Medicare enrollment process now will help you take full advantage of the program in the future. For example, you can find out how to avoid penalty fees, what parts of the program you are enrolled in automatically and what other plans you have to purchase for complete coverage. The sections below describe the different parts available, how much Medicare costs based on the coverage selected and how you can enroll.

What is Medicare?

The Medicare program is designed to provide comprehensive health insurance to older Americans. Signed into law in 1965, Medicare coverage was created to provide an affordable or free insurance option for older Americans who could not afford other coverage options. Today, the program has grown and expanded beyond its original goals. Now it provides comprehensive coverage that can include both inpatient and outpatient hospital visits, doctor’s visits and prescriptions, depending on the plan you choose to enroll in.

Medicare Part A

In general, Medicare Part A provides health insurance coverage for inpatient hospital treatment, nursing facility care, hospice care and home health care. Covered inpatient treatment includes all required lab work, hospital rooms and meals, required hospital services such as nursing or intensive care, rehabilitation services and more. Most individuals have no premiums under Part A, and low-cost coverage for certain forms of treatment.

Medicare Part B

Medicare Part B coverage includes medically necessary services and preventative services, such as flu shots. It also includes emergency and some non-emergency ambulance services, as well as mental health inpatient, outpatient and partial hospitalization services. Seeking a second opinion on a diagnosis and some prescription drugs may be covered as well. Finally, Part B provides medical equipment such as walkers and oxygen tanks, and some outpatient therapy services.

Medicare Part C

Part C is different from the other Medicare programs. Also known as the Medicare Advantage Plan, this option manages your Part A and B coverage and typically includes Part D as well. The plan may also offer additional benefits, such as dental and vision coverage. These plans are managed by private Medicare-approved companies, so they may be more suitable if you prefer the experience of private health insurance but qualify for Medicare.

Medicare Part D

Part D covers drugs prescribed to you by your doctor. You are generally required to purchase a Part D drug prescription plan if you want this coverage, as you are not automatically enrolled in it. Different plans offer varying terms, such as cheap or free generics, or a lower price for a particular drug. In some cases, you may be eligible for premium-free Part D coverage. It is important to carefully evaluate the terms of the prescription drug plans available to you before selecting one. You also was to keep your own medical needs in mind.

Medicare Eligibility

Medicare eligibility requirements vary based on a number of factors. Most people are automatically enrolled in Medicare when they turn 65 years of age. However, eligibility also depends on your work history. To receive automatic coverage with no premiums, either you or your spouse must have paid into the Medicare tax system for at least 10 years before enrolling. If any of the following is true, you can get Medicare Part A coverage without premiums:

  • You receive retirement benefits from Social Security or the Railroad Retirement Board (RRB).
  • You’re eligible to receive the above retirement benefits but have not applied.
  • You or your spouse were employed by the government and covered by Medicare in the past.

You can also get premium-free coverage if you are under 65 years of age. To qualify for this benefit, one of the following must be true:

  • You have received Social Security or RRB disability benefits for 24 months.
  • You have amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease.
  • You have End Stage Renal Disease (ESRD).

Even if you are not eligible for premium-free coverage, you may still be able to purchase Medicare coverage when you turn 65. The cost of premiums varies depending on how long you paid Medicare taxes. However, you may be required to purchase Part B as well in some cases. These premiums vary depending on your annual income the year prior.

Part D coverage is always optional. However, if you want this coverage you must typically purchase it. Medicare Part C plans are restricted by location, which means you must live in the service area of a particular plan in order to subscribe to it.

How much does Medicare cost?

Most people qualify for premium-free Medicare Part A when they turn 65 years of age. However, they may still have to pay for additional plans for complete coverage. The following price ranges are in place for Medicare plans:

  • Part A: Monthly premiums can cost up to $437. Most people qualify for free coverage.
  • Part B: Monthly premiums can cost up to $460.50, depending on your income. Most people pay around $130.
  • Part C: Variable. Visit the Medicare website to compare plans and premiums.
  • Part D: Monthly premiums can cost up to $77.40, depending on your income.

How to Sign Up for Medicare

You can sign up for Medicare Part A automatically when you apply for Social Security retirement benefits. In some cases, you may also be automatically enrolled in Medicare Part B. If you are eligible for Part B, but choose not to enroll in it immediately, you will be charged a fee for late enrollment.

If you are not automatically enrolled in Medicare, you should sign up during the general enrollment period. The general enrollment period lasts for seven months after your 65th birthday. There are three options for Medicare enrollment:

  • You can sign up online by visiting the Social Security website and filling out an application.
  • You can call the Social Security Office to enroll.
  • You can visit your local Social Security Office in person to enroll.