- We will talk here about what it is! Increasing age brings a unique set of health challenges for the majority of people. This is why older people tend to have higher health care needs and require more frequent hospital visits. With 80% of America’s older population living with at least one chronic disease[1], widespread access to quality health care is essential.
Medicaid is ensuring just that.
New to the world of health insurance? Don’t know much about it, its eligibility criteria, and what it covers? Don’t worry; we’ve got you covered!
This blog post is dedicated to educating people who’re just getting started with Medicare and helping them get the best of it.
Keep reading to get all the essential details that you need to navigate through this world…
What is Medicare?
It is the federal health insurance program primarily directed towards the elderly (people aged 65 or older). However, it also provides health care coverage to those under 65 if they have a disability, End-Stage Renal Disease (commonly known as kidney failure), or amyotrophic lateral sclerosis (ALS) (a neurological disorder).
Today, more than 63 million Americans have access to quality health care because of this government-run health insurance program, out of which about 9 million are under 65.
What Does Medicare Cover?
Overall, it helps beneficiaries pay for a range of healthcare services, including doctor’s visits, hospitalization, prescriptions medicines, and expenses for home health care and skilled nursing facilities. However, your exact coverage depends on the health plan you’re enrolled in.
Types of Medicare Health Plans and What They Cover
This health insurance program is comprised of four health plans – A, B, C, and D – that fall into the following three categories.
§ Original Medicare
The original is the most comprehensive coverage option. It is comprised of Part A and B. Let’s take a look at what each of these parts covers to better understand Original coverage.
Medicare Part A Coverage
Part A is Hospital Insurance, which pays for hospitalizations, including all inpatient services ranging from lab tests to surgeries. However, it’s not just limited to that. Part A also covers the cost of skilled nursing facilities (short-term stay), some home health care services, and hospice care.
Medicare Part B Coverage
Part B is Medical Insurance. It covers outpatient care, medical services necessary to diagnose and/or treat a health condition, and a range of preventive services, such as vaccines, screenings or procedures that can help detect a disease at an early stage, and yearly checkups. Part B also provides coverage for home health care and durable medical equipment necessary for a patient. These may include a hospital bed, walker, or wheelchair.
Part B also pays for the ambulance service and includes mental health coverage as well.
§ Medicare Advantage
Advantage is another name for Part C. Advantage plans are provided by government-approved private insurance companies and are typically more comprehensive than the Original plan. They also include the benefits of Part D (prescription medicine coverage).
Advantage Plans also often come with additional coverage options for hearing, vision, and dental care services.
§ Medicare Drug Coverage
Drug Coverage, or Part D, is dedicated to people who need help in paying for their medications. The plan covers the cost of prescription drugs, including both generic and brand-name drugs and a range of recommended vaccines.
Multiple private insurance companies offer Part D. Hence, the exact terms of the plan may vary in terms of what drugs are covered, the pharmacies you can buy from, and the amount you have to pay from pocket. However, all the companies are entitled to provide the standard coverage as per Medicare’s guidelines.
What are the Eligibility Criteria for Medicare?
From a broader perspective, all US citizens and those who have been legal permanent residents for at least five years become eligible for it at 65 years of age. However, as mentioned earlier, the program also provides health coverage to those under 65 under certain conditions.
From a more strict perspective, you can only become eligible for the premium-free Medicaid (which includes Part A only) under the following conditions:
People Aged 65 or Above
- You or your spouse were government employees (in a department or institution that Medicare-covered)
- You or your spouse paid Medicare taxes for at least ten years during the employment period
- You’re eligible for Social Security or Railroad benefits but have not applied for them yet.
- You’re receiving Social Security or Railroad Retirement benefits.
If you do not meet any of these conditions, you can still get Medicare Part A. But, you will have to pay a premium for it.
People Under 65
Those under 65 become eligible for premium-free Medicare as soon as they develop the approved health conditions. However, those who have a disability and are receiving Social Security disability insurance only become eligible for it after a period of two years.
What about Other Parts of Medicare?
Part B doesn’t come premium-free. Everyone must pay a monthly premium to enjoy Part B benefits. The same goes for Part C and D, which private insurance companies provide.
Find the Best Medicare Option for Yourself!
The various Medicare options, their eligibility criteria, and different ways to avail them can be quite confusing for many people. We at United Insurance are dedicated to clear this air of confusion and help people choose the best Medicare health coverage for themselves. Get in touch with us to get expert help in figuring out which option is best suited for you, according to your medical needs and budget.
Image Credits
Photo by Bermix Studio on Unsplash
[1] https://www.ncoa.org/article/get-the-facts-on-healthy-aging