Medicare is a Federal health insurance program available for US residents who are aged 65 or to younger people who are disabled or have certain health conditions that make them eligible for Medicare. These conditions include End-stage Renal disease (ESRD) and Lou Gehrig’s Disease (ALS). It is also available for people who are receiving retirement benefits and state or local government employees.
Dates for Enrolling
There are several different enrollment periods for Medicare.
There is the initial enrolment which is the seven-month period around and including your birthday. So, for example, if you are born in July, you will be able to apply as early as April and as late as October. Furthermore, there are extra costs associated with enrolling later than the initial period.
There is also general enrollment, which opens on the 1st of January and closes on the 31st of march.
After that, there is open enrollment, which runs from the 15th of October till the 7th of December.
If you miss these enrollment periods, then there is also special enrolment. Special enrollment may apply if your eligibility changes outside the normal enrollment periods.
Original Medicare is the traditional insurance program offered. The plan comprises two parts, Part A and Part B.
Part A covers things such as inpatient hospital care, surgery, lab tests, some home care and skilled nursing facility care. Generally, people are automatically signed up for Part A when they turn 65 and won’t pay a premium if they have paid Social Security for at least ten years.
Part B is what you enrol for during the initial enrollment period. Part B covers two types of services. These are preventative services (such as shots and screenings) and medically necessary services. Doctor visits, clinical research, medical equipment, ambulance services, mental health, limited outpatient prescription drugs, and outpatient care all come under medically necessary services. Part B coverage requires a monthly premium to be paid based on your income. As of 2023, coverage starts at $164.90 each month.
It’s also important to be aware of what Part A and B do not cover. Hearing aids, dentures, eye exams, dental care, long-term care, cosmetic surgery, massage therapy, routine physical exams and concierge care are not covered by Part A and Part B.
However, Original Medicare does not cover all costs associated with medical care as you are required to pay 20% coinsurance. Many people either opt for a Medicare Supplement Insurance Policy (also known as Medigap) or a Medicare Advantage plan to avoid paying out-of-pocket costs for copayments and deductibles.
Medicare Advantage (Part C)
Medicare Advantage plans offer all the benefits of Original Medicare but are provided by private insurance providers. They include extra benefits such as…
- Dental and vision care.
- Prescription drug coverage (Known as Part D).
- Gym memberships.
- Transportation to and from medical appointments.
- Home Delivered Meals.
- Personal Emergency Response Systems.
Some Medicare Advantage plans only require you to pay the premium for Part B, whereas others will require extra premiums to be paid depending on the level of coverage needed.
Prescription Drug Coverage (Part D)
If Medicare advantage doesn’t sound like something you are interested in, but you take a regular medication prescription, you can join a Medicare-approved drug coverage plan. Premiums vary depending on the plan and the drug that you require.
Medicaid is a federal and state program for people with low incomes or limited resources. Eligibility requirements for Medicaid vary from state to state. Still, those who are eligible for Medicaid will receive assistance paying for their Part B premiums, some out-of-pocket costs and prescription drug costs.
Contact your state medical assistance office to understand if you are eligible for Medicaid.
It is important to note that you should always consult a licensed insurance provider when determining your Medicare needs. Here are some things you should consider before getting further advice from a specialist.
What are your health care needs? Do you have any underlying conditions, have chronic pain, or take regular prescriptions? Ensure that the plan you choose covers your needs.
Consider the costs of the plan. What are the premiums, and are there any out-of-pocket costs?
If you choose a Medicare Advantage plan, be sure to check if your preferred providers, hospitals and clinics are part of the plan.
Nothing is more important than your health. So, be sure to check the ratings of the plan you are choosing so you can be satisfied with the service that will be provided.