Medicare is a medical insurance program in America. The US government runs it through the Centers for Medicare and Medicaid Services (CMS). The program’s main aim is to help with costs associated with health care.

Most Americans find it necessary to enroll in Medicare as it substantially helps reduce medical expenses. The following discussion helps you better understand Medicare’s eligibility, coverage options, enrollment periods, and what it does and does not cover.

Who is Eligible?

The Social Security Administration determines Medicare eligibility, and most persons receiving Social Security benefits qualify for the program. Generally, a person must be at least 65 years to qualify for Medicare. However, there are exceptions for those under 65 receiving disability benefits or having a diagnosis such as End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS).

What Options are Available for Coverage?

Medicare has several coverage options, including:

Part A

This coverage functions as hospital insurance by providing inpatient care and home healthcare services. You would qualify for premium-free coverage if your spouse or you paid Medicare taxes for ten years and above. Otherwise, you will only qualify for the plan if you pay a monthly fee. It is important to note that the premium to be charged considers the amount paid into Medicare taxes. Your monthly premium will be less if you have paid more taxes.

Part B

Medicare Part B acts as medical insurance and covers costs related to outpatient care, medical equipment, preventative care, and healthcare provider services. This coverage option requires you to pay a monthly fee. Your annual income determines the monthly premium you will pay. Most times, if you have a higher income, you are likely to be charged a higher premium.

Part C

This coverage is also the Medicare Advantage plan. Medicare-approved private insurance providers offer this coverage. The option includes everything that Parts A and B cover, making it an alternative to Original Medicare coverage, which constitutes Part A and B insurance. Some Medicare Advantage plans offer additional benefits such as prescription medicine coverage and routine dental, vision, or hearing care.

Part C plans also require you to pay a monthly premium. The premium charge varies depending on the plan you choose.

Part D

This option is the drug coverage plan which covers the costs related to prescription meds. Sometimes, the coverage also covers expenses related to recommended vaccines and shots. Most Medicare Advantage plans include the Part D option. However, if your insurance does not have Part D, you can enroll separately.

Medigap

This coverage is also the Medicare Supplemental Insurance plan. Just as the name suggests, this plan supplements other coverage. Medigap shares the costs associated with Parts A and B of Original Medicare. Costs such as; copayments, coinsurance, and deductibles. Additionally, this option fills any gaps in a Medicare plan. Private insurers pre-approved by Medicare offer this coverage.

Is There a Period for Enrollment?

There are various periods that you can enroll for Medicare.

Initial Enrollment Period

This period serves as your first chance to enroll for Medicare. The period is a seven-month window that starts three months before you turn 65. It then includes the month you turn 65 and closes three months after you turn 65. Missing this window does not entirely limit you from enrolling for Medicare. However, late enrollment may attract penalties.

Suppose you have a disability and are below 65. In that case, you are also eligible to enroll in Medicare’s Part C or D. Your seven-month window starts three months before your 25th month of receiving Railroad Retirement Board (RRB) disability benefits. It then includes the 25th month of receiving disability benefits and closes three months after your 25th month.

Special Enrollment Period

If you are 65 years or older, still working, and have group health insurance coverage, your window begins when your coverage expires or you lose your job, whichever comes first. The window only lasts for eight months. If you fail to enroll during this period, you will have to wait for the General Enrollment Period, which may attract penalties for late enrollment.

The Special Enrollment Period also accommodates you if you are disabled and below 65. The only limitation is that you can only qualify to sign-up for the Original Medicare plan and not any other coverage.

General Enrollment Period

If you were unable to sign-up for Medicare during the Initial Enrollment Period and the Special Enrollment Period, the General Enrollment Period gives you a chance to enroll. This period runs annually from the 1st of January to the 31st of March. It is important to note that signing up during this period may sometimes attract penalties.

Medicare Advantage Open Enrollment Period

It runs from the 1st of January to the 31st of March of each year and is only eligible for people with a Medicare Advantage plan. During this time, you are free to switch to an Original Medicare plan or another Medicare Advantage plan.

Open Enrollment Period

The period starts on the 15th of October and ends on the 7th of December annually. You can drop, switch, or join a plan during this time.

What Does Medicare Not Cover?

It is prudent to point out that Original Medicare does not cover all healthcare services, and some might necessitate you pay from your pocket. Some services that Original Medicare does not cover include;

• Long-term care
• Acupuncture
• Cosmetic surgery
• Dental, vision, and hearing care.
• Dentures

If your Original Medicare plan does not cover your needs, consider adding a supplemental plan (Medigap) or switching to a Part C plan.

Medicare is an essential healthcare program that benefits millions of Americans. You need to understand the coverage options available, the enrollment periods, and what is and what is not covered to enable you to make an informed decision.

Published by HOLR Magazine.