What is Medicare?

If you are a senior citizen as deemed by the Social Security Administration, you may be eligible to receive Medicare health coverage.

While Medicare insurance is not entirely free, Medicare allows you to tailor your coverage based on what you can afford and the coverage you need. Additionally, some portions of Medicare, such as Part B, include a sliding scale premium that is based upon your income. Those with higher incomes will be expected to pay more for Medicare insurance while lower-income individuals may pay a lower premium cost. Additionally, low-income Medicare beneficiaries may be able to receive additional aid from state Medicaid programs. If you are considered dually eligible, you will likely receive additional benefits such as extensions to your Medicare coverage and assistance with paying Medicare out of pocket costs.

If you are interested in Medicare, it is important to understand what Medicare is, including who the program is intended for and what Medicare health insurance has to offer you. To learn more about the Medicare program, review the information that has been provided within the sections below.

The Development of the Medicare Program

Created in 1965, Medicare was originally designed to provide health coverage to senior citizens who are ages 65 and older. In 1972, the program was expanded to include disabled individuals of all ages. Maintained by the federal government and administered by the Social Security Administration (SSA), Medicare accounts for roughly 15 percent of the federal budget in recent years. Medicare is also partially funded by taxes. It is estimated that about 13 percent of Medicare recipients are ages 85 and older. Today, over 59 million American citizens receive Medicare health coverage.

Who is Medicare for?

Medicare was originally only provided to senior citizens, but later came to include disabled individuals. In order to be considered qualified for Medicare health insurance, one of the following must apply to you:

  • You are at least 65 years old
  • You are under 65 years old, but you have been diagnosed with amyotrophic lateral sclerosis (ALS), which is also referred to as Lou Gehrig’s Disease, or you have end-stage renal disease (ERSD)
  • You are under the age of 65, but you have been granted Social Security Disability benefits for a minimum of 24 months

It is also worth knowing that in order to be eligible for Medicare health insurance, you must either be a United States citizen or a legal permanent resident for a minimum of five consecutive years. If you are a current or former spouse of an individual who receives Social Security or Railroad retirement benefits, you are also eligible to receive Medicare, even if you are divorced or your spouse is deceased.

It is also worth knowing that even if you do not meet any of these requirements, you may still be able to purchase Medicare Part A should you choose to pay a monthly premium. However, Medicare Part A will only provide you with “hospital insurance.” It will not provide you benefits towards visits to your doctor, laboratory work, prescription drugs, etc.

Learn About Medicare Benefits and Plan Options

Medicare health insurance allows you to choose plans based on the coverage that you would like to receive and the cost in which you are comfortable with paying. Medicare is essentially split into four parts: A, B, C and D. Each Medicare part does provide a different array of benefits such as hospital insurance, prescription drug coverage and general insurance.

Medicare Part A and Part B are considered “original Medicare,” while C offers hybrid plans that are more all-inclusive. Part D will only provide prescription drug coverage, which is also offered within some Part C plans, depending on the plan you choose. Part A will generally only give “hospital coverage” whereas Part B will provide coverage such as doctor visits, laboratory work, x-rays and wellness exams.

You must also apply for Medicare during one of the enrollment periods. Generally, your initial enrollment period will begin three months prior to your 65th birthday and end three months after your birthday. If you do not enroll during this initial enrollment period, you may have to wait until the general enrolment period that is held annually. In some cases, you may be given an exception and qualify for a special enrollment period. Special enrollment periods are generally available during any month that you are covered under a group health plan through your own employment or that of your spouse. This special enrollment period will only last for eight months after that coverage ends your employment ends, whichever comes first.

As mentioned previously, you will be able to enroll in Medicare during open enrollment, but you should be aware of the additional cost in premiums that you may have to pay for certain parts of Medicare. For example, Medicare Part B charges a slightly higher premium for every year that you were eligible for Medicare, but did not enroll into the program.

Find Out About Low Income Medicare Beneficiaries

Of the estimated 59 million Americans who receive Medicare benefits, 8.3 million people also receive assistance from Medicaid. Unlike Medicare, Medicaid is designed for low income individuals and families in order to provide health insurance coverage to the neediest citizens across the United States. If you are eligible for both Medicare and Medicaid, you are considered “dually eligible” and you can receive benefits from both of these government programs. Dually eligible beneficiaries will often receive additional coverage options for medical insurance, such as care beyond the 100 day limit of nursing facility care and in some states you may be eligible for prescription drug coverage, eyeglasses and hearing aids. Medicaid will often aid recipients in paying for Medicare bills including out of pocket costs such as deductibles, premiums and copayments. In most states, Medicaid is available at little to no cost. It is worth knowing that you will need to apply to both Medicare and Medicaid in order to receive benefits.

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