What is Medicare? It is a federal health insurance program in the United States that provides coverage to individuals aged 65 and older, certain younger people with disabilities, and individuals with end-stage renal disease (chronic kidney failure requiring dialysis or a transplant). This program is administered by the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services.
Components:
Medicare Part A (Hospital Insurance)
- Coverage: Part A covers hospital care, skilled nursing facility care, hospice care, and some home health services.
- Costs: For most people, Part A has no premium if they meet the 40 credits requirement. However, there are deductibles and coinsurance associated with the covered services.
Medicare Part B (Medical Insurance)
- Coverage: Part B covers medical and preventive services, such as doctor visits, outpatient services, durable medical equipment, and some home health services.
- Costs: Part B has a monthly premium, which varies based on income. It also includes deductibles and coinsurance.
Medicare Part C (Medicare Advantage)
- Coverage: Part C is an alternative to Parts A and B, offered by private companies approved by Medicare. These plans must cover all services provided by Parts A and B and often include additional benefits like prescription drug coverage.
- Costs: Costs and benefits can vary depending on the specific plan and region.
Medicare Part D (Prescription Drug Coverage)
- Coverage: Part D helps cover the cost of prescription drugs. Plans are offered by private insurance companies approved by Medicare.
- Costs: Costs include monthly premiums, deductibles, coinsurance, and copayments. Specific costs vary depending on the plan and the covered medications.
Who is Eligible?
Eligibility is generally based on age, disability status, or the presence of end-stage renal disease.
People Aged 65 and Older
- Requirements: They must be U.S. citizens, permanent legal residents, or have another immigration status and have lived in the U.S. for at least five consecutive years.
- Medicare Contributions: They must generally have worked and paid Medicare taxes for at least 10 years.
People Under 65 with Disabilities
- Social Security Disability Insurance (SSDI) Recipients: After receiving SSDI benefits for 24 months, individuals automatically become eligible for Medicare.
People with End-Stage Renal Disease (ESRD)
- Specific Criteria: Individuals with ESRD who require dialysis or a kidney transplant may qualify for Medicare, regardless of age.
How to Enroll?
Enrollment can be automatic or may require an application, depending on the individual’s situation.
Automatic Enrollment
- Social Security Beneficiaries: Individuals already receiving Social Security or Railroad Retirement Board benefits are generally automatically enrolled in Medicare Part A and Part B when they turn 65.
Manual Enrollment
- New Applicants: Those not receiving Social Security benefits must manually enroll in Medicare through the Social Security website, by phone, or by visiting a Social Security office.
Medicare is a vital program that provides health coverage to millions of people in the United States, especially those aged 65 and older and those with disabilities. Understanding the different parts and enrollment processes is crucial to fully taking advantage of the available benefits. Would you like to know if you’re eligible? Contact an expert advisor now for more information by calling 786-453-8070.