Since the 1960s, Medicare, the largest public health program in the United States, has been providing health care insurance for seniors over 65, younger people with disabilities, and those with end-stage renal disease.
Today there are 62.6 million people in the country who count on the Medicare program for their health care benefits. From everyday care like doctor’s visits and lab tests; hospital and nursing home services; and prescription drugs, Medicare helps millions of beneficiaries get affordable and accessible health care.
If you’re looking forward to Medicare enrollment soon, you might be wondering just what Medicare is, so here’s a closer look.
What are the different parts of Medicare?
When you become eligible for Medicare insurance, you have two options for your coverage. You can either stay with Original Medicare Parts A and B, or you can enroll in a Medicare Advantage plan.
Original Medicare is managed by the federal government and is divided into two parts which cover specific health care services:
- Medicare Part A is your hospital insurance. It covers inpatient hospital care, skilled nursing care, and hospice care. It also includes certain home health care services.
- Medicare Part B is your outpatient medical insurance. It covers certain services that you get from your doctor, outpatient care, durable medical supplies, and preventive services.
Medicare Part C, also known as Medicare Advantage, is an alternative way for beneficiaries to get their Medicare Part A and B benefits.
When you are eligible for Medicare, you can choose to get your Part A and Part B benefits from Original Medicare or you can enroll in a Part C Medicare Advantage (MA) plan from a private insurance company that works with Medicare. Your MA plan is required by federal law to provide, at least, all the benefits that Medicare Part A and B provide.
The MA provider also has the option to include extra benefits in the plan. Most Medicare Advantage plans add in health care benefits like routine vision care, hearing care, dental care, and prescription drug coverage. Many plans also have additional coverage for things like fitness club memberships, and more.
Medicare Part D prescription drug benefits
For Medicare beneficiaries, having prescription drug coverage is an option and a personal choice, but it can be a vital addition to your medical coverage. If you want assistance paying for your prescription drugs, you can either purchase a stand-alone Medicare Part D plan or sign up for a Medicare Advantage plan that includes prescription drug benefits.
Part D plans are sold by private insurance companies. They are required to include at least two drugs for every category of drug they must cover. Adding more drugs in each category is an option for the plan provider, but most do. Before enrolling in a plan, you should ask to see the plan’s formulary to ensure that your drugs are covered.
What is Medicare eligibility?
No one can sign up for Medicare insurance coverage unless they meet the following eligibility requirements set by the U.S. federal government:
If you are 65 years old or older, you qualify if:
- You are a U.S. citizen or permanent (legal) resident living in the country for at least five years which don’t need to be consecutive years.
- You are getting retirement benefits from either the Social Security Administration or the Railroad Retirement Board, or you are entitled to these benefits but not yet receiving them.
- Either you or your spouse is employed by the government, or has retired from a government position, and has paid Medicare withholding taxes during this employment.
If you are younger than 65, you may qualify if:
- You have been receiving, or have been entitled to receive, Social Security disability benefits for at least 24 months. It isn’t necessary for the 24 months to be consecutive months.
- You get disability benefits from the Railroad Retirement Board, and you fulfil other requirements.
- You have amyotrophic lateral sclerosis (ALS). In this case you qualify for Medicare benefits immediately after diagnosis.
- You have end-stage renal disease that requires dialysis or a kidney transplant. You or your spouse must have paid SS taxes for a certain amount of time that depends on your age.