Who Is Eligible For Medicare?

Medicare covers several health aspects of an individual aged over 65 and people with disabilities. There are several plans created to cover different types of health and medical conditions. 

The medicare plan generally covers people of age older than 65, people younger than 65 who have qualified disabilities, and someone who is suffering from end-stage renal disease. 

In this article, we will learn about the different types of medical coverage and their eligibility. Also, we will be going through the process of applying for Medicare: 

What Are The Eligibility Requirements For Medicare? 

Age 65 

Those who are 65 years of age or older, U.S. citizens, who have been in the country for more than 5 years are eligible for Medicare benefits. The individual or their spouse must also have paid Medicare payroll taxes for more than 10 years. 

Permanent Residence 

Permanent residents who have worked for at least 10 years in occupations where they or their spouses paid Medicare payroll taxes and are at least 65 years old are eligible for Medicare Part A which is premium-free.

U.S. Citizen 

If you pay the Part A and Part B premiums and are a citizen of the United States, you can enroll in Medicare at age 65. If you have a green card but don’t meet the requirements for employment, you can only enroll in Medicare if you’ve been continuously residing in the country for at least five years.

Alien 

Being an alien who has been legitimately accepted for permanent residence and who has lived in the country for five years in a row previous to the month of submitting a Medicare application.

Social Security 

After a 24-month qualifying period, everyone who qualifies for Social Security Disability Insurance (SSDI) benefits is also qualified for Medicare. The waiting period for Medicare coverage is the initial 24 months after being eligible for disability benefits.

Railroad Retirement Board (RRB) 

The program covers all railway retirement beneficiaries who are 65 years of age or older as well as any other individuals who are directly or potentially eligible for railway retirement benefits. Beneficiaries are still eligible for Medicare at age 65, even though the age limits for various unreduced railway retirement benefits have increased in line with social security standards.

End-Stage Renal Disease (ESRD) 

If you were receiving Medicare benefits due to ESRD at the time of your kidney transplant, you might be qualified. You don’t need or anticipate obtaining certain forms of additional health coverage.

Lou Gehrig’s Disease (ALS) 

The first month you receive SSDI or a railroad disability annuity payment, if you have been diagnosed with Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease, you are eligible for automatic enrollment into Medicare.

How Do I Apply For Medicare? 

Social Security Administration

You can take these steps to sign up for Medicare:

  1. Online: Accessing the Social Security Administration’s website is the simplest and quickest option to register. To enroll in Medicare or submit a benefits application, you must first set up a secure My Social Security account.
  2. Phone: The Social Security number is 1-800-772-1213. Call 1-800-325-07781 if you use a TTY.
  3. In-person: Visit your neighborhood Social Security office.

Railroad Retirement Board (RRB) 

To enroll in Medicare, get in touch with your neighborhood RRB office around three months before your 65th birthday. Even if you don’t intend to retire at age 65, you can sign up for Medicare.  When you become eligible for Medicare and are currently receiving retirement or disability annuity payments, RRB will enroll you in Original Medicare (Parts A and B) immediately. 

What Are The Costs Of Medicare? 

Premium 

The typical monthly premium for Medicare is $164.90 for Part B, $28 for Medicare Advantage, $49 for Part D, and $155 for Medicare Supplement. However, depending on the coverage you select and other elements like having a high income, your monthly prices could change.

Deductible 

Before Original Medicare begins to pay, the Part A deductible for each inpatient hospital coverage period is $1,600. Before Original Medicare starts to pay, there is a $226 annual Part B deductible. One time a year, you must pay this deductible.

Copayment 

Most often, copayments are required for specialist and doctor appointments as well as prescription medication refills. The cost entirely depends on your plan, although the majority of copayments fall between $10 and $45+. For covered treatments and prescription drugs, several Medicare components, such as Part C and Part D, impose copayments.

Coinsurance 

You will be required to pay the following approx coinsurance if you have Medicare Part A and are admitted as an inpatient to a hospital:

  1. Days 1 through 60: No coinsurance.
  2. Days 61 through 90: daily coinsurance of $371
  3. Day 91 and later: $742 per day of lifetime coinsurance (up to 60 days in your lifetime).

Here is a breakdown of coinsurance expenses if you are admitted to a skilled nursing facility:

  1. Days 1 through 20: No coinsurance.
  2. Day 21 to Day 100: $185.50 per day coinsurance
  3. All charges from Day 101 forward

With Medicare Part B, you normally pay a 20% coinsurance of the Medicare-approved price for the majority of outpatient treatments and durable medical equipment once you meet your deductible ($203 in 2021).

 

How Does Medicare Work? 

Health Insurance 

Medicare is a federal health insurance program available to those 65 and over, as well as some disabled individuals and those with end-stage renal illness. Despite being a federal program, it is run by private businesses.

Government Programs 

Medicare is one of the health programs offered by the government. Medicaid is a combined federal-state program that offers low-income individuals and families health insurance. Another collaborative federal-state initiative that offers low-income kids health insurance is the Children’s Health Insurance Programme (CHIP).

Retirement – Disability

Medicare is neither a retirement nor a disability insurance program. It is a system of medical insurance. However many seniors and those with disabilities rely on Medicare as their health insurance.

If you’re retired and enrolled in Medicare, you may have health insurance from past work. If so, Medicare will be your primary payer, and the insurance plan through your work will be your secondary payer.

What Are The Benefits Of Medicare? 

Coverage 

Medicare offers a wealth of health benefits and covers a variety of medical services, such as prescription drugs, doctor visits, and preventative care. You can maintain your coverage even if you relocate because Medicare is accessible almost in every state of the US. You cannot be denied coverage under Medicare because of pre-existing conditions since it is a guaranteed acceptance program.

Affordability 

Low administrative costs and large provider networks are two key benefits of Medicare.  Traditional Medicare could be improved by stabilizing the insurance market for people looking for individual coverage or small-employer groups who are not yet Medicare-eligible.

Access To Care 

Nearly all Americans aged 65 and over, as well as millions of persons with chronic impairments, now rely heavily on Medicare as a source of financial and health security. Medicare also dramatically increased access to care for senior Americans.

What Are The Drawbacks Of Medicare? 

Limitations

Due to the limited provider networks of Medicare Advantage plans you might not be able to see your regular doctor or hospital. For some treatments, including doctor visits and hospital stays, some Medicare Advantage plans need prior authorization. This process could be tedious and upsetting. The annual enrollment period, which runs from October 15 to December 7, is the only time you can sign up for or switch Medicare Advantage plans.

Out-of-pocket Costs 

Medicare does not pay for all of the expenses related to medical care. Medicare beneficiaries are responsible for covering out-of-pocket expenses such as copays, deductibles, and premiums. Some people, particularly those with fixed incomes, may find out-of-pocket expenses to be burdensome.

Coverage Gaps 

Not all medical services are covered by Medicare. For example, dentistry, eye, and hearing care are not covered by Medicare. Long-term care services like nursing home care are likewise not covered by Medicare. Medicare beneficiaries who want to pay for services that Medicare does not cover can buy supplemental insurance coverage. 

What Are Some Common Misconceptions About Medicare? 

Eligibility 

There are more ways to qualify for Medicare than just being 65 or older, despite the common misconception that this is the sole way to sign up for the program. You might be qualified if you’re under 65 and suffer from a particular disability. For instance, regardless of age, you might be able to sign up for Medicare if you have chronic kidney disease that necessitates dialysis or a transplant.

Coverage 

It is untrue that Medicare pays for all of your medical bills. You might be shocked to learn that Original Medicare (Parts A and B) is not a free program if you are new to Medicare. Your medical expenses are only partially covered by Original Medicare. The cost of the premiums, deductibles, coinsurance, and copayments falls on you, which could be substantial at times. 

Costs 

Medicare is divided into various components. There are various charges related to each component. Additionally, you can combine components to create coverage that meets your medical needs.   Part A pays for hospital care-related costs. Medicare Advantage, sometimes referred to as Part C. Prescription drug benefits are provided through Part D. As a result, the price for each element depends on your selection.

How Can I Compare Medicare Plans?

FeatureMedicare AdvantageMedicare SupplementPart D
Type of planCombining Part A and Part B coverage, offered by private companies, with potential for prescription drug coverage and other benefits.Private businesses provide this service to aid with expenses that Medicare does not cover.Helps pay for the cost of prescription medications offered by private businesses
CoverageMust provide all services covered by Original Medicare, but may also provide extra benefitsHelps to pay for expenses like deductibles, coinsurance, and copays that Original Medicare doesn’t cover.aids in paying for prescription medicine costs
Provider networkLimitedany medical facility or doctor who accepts MedicareLimited
CostSome programs don’t charge a monthly premium, however, some doHas a recurring monthly feeA deductible, coinsurance, and monthly cost.
EnrollmentBetween October 15 and December 7 of each year, or during a special enrollment periodDuring any season of the yearBetween October 15 and December 7 of each year, or a special enrollment period

How Can I Choose The Right Medicare Plan For Me? 

Needs Assessment 

Determine what you need from your healthcare coverage before looking at particular Medicare Advantage plans. Make a list of all of your medicines first, then make a note of your favorite drugstore. The type of managed care network, the maximum out-of-pocket expense, the expenses of copays and deductibles, etc. should also be taken into account.

Cost Comparison 

Now cost is the main thing that comes to mind when choosing your medicare plan. The cost varies according to the location, facilities, and some extra advantages as per your plan. When you are eligible for Medicare you should always compare the prices of all the plans, and check if you need extra facilities or a minimum coverage will be fine, it all depends upon your needs. 

Coverage Comparison

Comparing the coverage is crucial because it aids in your search for a plan that best fits your requirements and financial situation. The advantages, and limitations of each choice can be assessed by contrasting various plans. This gives you the information you need to decide wisely and pick the plan that will best meet your unique medical requirements.