If you are over 65 or have helped look after an elderly member in your family, chances are you would have heard of the term Medicare. You may even have some knowledge of the benefits it provides. But in order to take full advantage of the program, you need to familiarize yourself with the details. For example, what kinds of services it does or doesn’t cover, or whether the program is only intended for those over 65.
Let’s learn all the basics of the Medicare program. Starting with simple questions such as “What is Medicare?” and “Who does it cover?”, before moving onto the benefits offered by different parts of the program.
Medicare is one of the national health care programs started and funded by the United States Federal Government. It provides affordable health insurance coverage to people who are 65 or above, as well as those with certain disabilities. It also covers people with amyotrophic lateral sclerosis and end stage renal disease.
The program was first introduced ibn 1966, though it has continued to evolve over the years. The agency in charge of the program is called The Centers for Medicare and Medicaid Services.
Normally, you can sign up for the program once reaching retirement age. Though if you are still working and have health insurance coverage from your employer, we would strongly recommend that you stick with that until you actually retire.
When you begin to approach retirement age, you’ll learn more about open enrollment. That is the period of time that starts three months before you turn 65. It will end 3 months after your birthday. That means you need to be able to act within that 7 month timeframe.
If you become disabled or qualify for Medicare due to other health conditions, you can apply for Medicare directly at any time. You’ll need to meet the government’s requirements for qualifying based on your health condition.
One thing you may find confusing while looking at any federal health insurance program is the different “parts” that are available to applicants. But don’t worry, we’ll break it down for you.
Also known as the “basics” of Medicare coverage, it normally refers to Medicare parts A and B.
Medicare Part A is essentially hospital insurance. It covers the costs incurred when you get admitted to the hospital, including the following:
Inpatient care at the hospital
Hospice care at the end of life
Skilled nursing facility care
Home health care, with limitations
Part B is the part for medical insurance, which covers doctor visits and some preventative screenings you need, which includes
Outpatient care at your doctor’s office
Home health care, in some cases
Doctor care at a facility when you do not stay overnight
Durable medical equipment, such as lifting equipment, wheelchairs, and hospital beds, you may need at home
Preventative health care and screenings
One important thing to remember is that neither Part A hospital insurance nor Part B medical insurance covers prescription drugs, nor dental and vision care.
Because of this, many people with Original Medicare will need Medicare Part D, a Medigap plan or Medicare Advantage Plan options, which provide an extension of coverage beyond what Original Medicare offers.
Many private insurance companies provide Part D coverage, which is not offered by the federal government. While choosing, we recommend that you compare policies to find the best one for your needs.
Medigap coverage, also known as Medicare Supplement Insurance, can help fill in some of the gaps not covered by Original Medicare, such as copayments, coinsurance, and deductibles.
It does, however, come with limitations. For example, it does not cover prescription drugs. This is a big problem for many people as medications can be expensive thus creating a huge financial burden and will need to also get a PDP plan.
An alternative to Medigap are Medicare Advantage plans, sometimes called Medicare Part C or MA Plans. These are policies from private insurance companies that follows specific rules and regulations set by the federal government.
Medicare Advantage plans often include medication coverage. That means when you purchase the plan, it’ll cover all the combined benefits offered by Original Medicare, Medigap and Medicare Part B, and sometimes even more. The following are some examples of the areas that maybe covered in a Medicare Advantage plan:
Emergency medical care
Urgent medical care
Preventative services like wellness checkups
Home health services
All medically necessary services that are provided under Original Medicare
Hospice care
Some plans include vision, dental, and cash cards to help you with additional costs
Some plans cover things like fitness programs, like a gym membership or discounts.
Transportation to doctor’s visits.
Over-the-counter health and wellness medications not covered by Part D
There’s a lot more to the Medicare program and how it can protect you. For example, what are the monthly premiums you are responsible for when buying different parts of the program, and what out-of-pocket costs you may face?
It’s important that you thoroughly research your options or speak with a licensed health insurance agent who can explain the plans and help you pick a plan that best suits your needs.
