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About 10,000 Americans turn 65 years old each day, which means they’re at the right age for Medicare. This is a national health care program by the government. Most Americans are eligible for it, but there are some important things you have to know about it first.
Here’s Medicare 101, where we’ll answer some common questions like, “how old to get Medicare?” or “what are the eligibility requirements for Medicare?” Dive in and learn more about how you can get the most out of your coverage.
Medicare 101: What is Medicare?
Medicare is a government program that provides health care access to eligible Americans. Today, it’s usually for Americans 65 years old or older. Children with certain disabilities and those with ESRD are also eligible.
A division of the US Department of Health and Human Services (HHS), which is The Centers for Medicare & Medicaid Services (CMS), administers the program. The POTUS also oversees this division.
The federal health insurance program has existed thanks to President Lyndon B. Johnson. He signed a bill creating Medicaid and Medicare in 1965.
Before that, however, President Harry S. Truman and President John F. Kennedy also implemented similar programs.
It has changed since then, with President Truman being the first to enroll in the Medicare we know today. It makes up 15% of the federal budget. Its other funding coming from the Social Security and Medicare taxes and premiums.
Coverage and Benefits of Medicare
The benefits of Medicare differ according to the part of the Medicare program you’re enrolled. You will most likely recognize some of the healthcare and medicare brands based off their names and logos they have posted in brochures and sometimes on TV.
The Original Medicare includes Parts A and B; it’s the traditional program offered through the federal government. On the other hand, we have the Medicare Advantage Plan, which includes Parts C and D.
Wait, what is Medicare Advantage and is it not through the federal government? It’s a program that private insurance companies offer, but it’s in contract with the CMS. Let’s take a look at how each part differs and what benefits they have.
Part A: Hospital Coverage
As the name indicates, Part A of Medicare covers hospital care. It also covers skilled nursing care in a facility, hospice care, and home health care services, but only to an extent. It can also cover blood transfusions after the first three pints every year.
Although it says that, Medicare doesn’t usually cover the whole amount of your hospital bill. You’ll likely have to pay for a share of the cost, plus you’ll have to pay a deductible before the coverage begins.
This Medicare program is a requirement by law in most cases; there’s a penalty to pay if you don’t enroll. Most Americans would get a premium-free Part A once they turn 65 years old. This is because of the taxes they or their spouses paid while working.
If you’re not eligible (i.e. you haven’t worked for at least 40 quarters), you’re going to have to pay for a Part A coverage.
Part B: Medical Coverage
On the other hand, Part B covers preventive services, such as therapy, counseling, annual wellness visits, shots, screenings, tests, and more. On top of that, it also covers 80% of the costs of other medical services. Examples are home health services, x-rays, ambulance, and such.
The coverage will kick in if the service is a medical necessity. It should be a preventive step for a condition or disease.
Unlike Part A, Part B coverage requires you to pay a premium each month. The federal government sets the standard, but the cost would depend on your income. You also have to pay a deductible each year before the coverage begins.
Part C: Medicare Advantage
As we’ve mentioned above, this comes from a private insurance company as a replacement for Part A and B plans. As required by the CMS, it should at least have the same benefits of both plans.
Usually, its coverage is wider. It might also include cover dental, hearing, and visual services, as well as gym memberships.
Aside from that, the only difference with the Original Medicare is that the private company takes care of the coverage and premiums for you. In turn, you pay them a premium, which might even be lower than the fee you pay for the Part B plan. Depending on the plan you choose, you might have to continue paying for Part B.
As such, it’s optional to enroll in Part C.
Part D: Prescription Drug Coverage
Part D is an optional coverage and it’s a standalone prescription drug plan. Like Part C, it’s available through private insurance companies. You’ll have to pay a premium for this one, which will vary among different companies.
Medicare Requirements and Eligibility
Enrollment to Original Medicare is automatic in most cases. You’re eligible if any of these applies to you:
- You or your spouse paid for Medicare taxes.
- You get retirement benefits from the Social Security or the Railroad Retirement Board.
- You’re eligible to get retirement benefits from any of the above.
You can also be eligible if you’re under 65 years old if one of these applies to you:
- You have an end-stage renal disease.
- You’ve received disability benefits from the Social Security or Railroad Retirement Board for 24 months.
If enrollment isn’t automatic for you, you have to contact Social Security to be able to apply.
For private plans, the requirements are the same for the most part. However, you do have to already have an Original Medicare plan before you enroll. You also have to live in a covered service area.
Learn More About Medicare
Medicare is a good program for the aged, showing how the government cares for the people who worked hard for their country.
It helps to know all about it before you turn 65 years old to help you understand your coverage. We hope this Medicare 101 guide helped you answer your questions about it.
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