We all understand the role that insurance has in financially protecting us and our loved ones from life’s uncertainties, but accurate information about insurance can often be difficult to come by. This is especially true in the case of healthcare insurance options, and particularly for the elderly and the vulnerable, figuring out the coverage and pricing of these plans can be a real burden. Medicare is one governmental healthcare program that can help really help vulnerable people cover their medical costs, and even though most people have heard of Medicare, there is still a lot of confusion about the way it works.
Whether you are new to Medicare or are trying to stay informed and up to date about this federal healthcare insurance program, here is our extensive guide to Medicare.
1. What Is Medicare?
Medicare is a federally-funded health insurance program for the elderly (people aged 65 and older), along with patients that suffer from chronic conditions and disabilities. Medicare can be used as either primary healthcare insurance or supplemental, backup coverage and will help you to pay for a wide variety of medical expenses. It is funded by taxes, but in some cases, you will have to pay for the premium – either separately or as a part of your social security checks. Some people mistake Medicare for a completely different program called Medicaid, which offers health and other services for eligible low-income people of all ages with little savings but they are different programs.
2. Tips For Choosing A Medicare Plan
There are various Medicare options available. It is important to have accurate information that explains the advantages and disadvantages of these plans. Here are some tips that will help you choose between them:
- Take your healthcare costs from last year into consideration to get a good idea of which plans will save you the most money.
- Make a list of your medical conditions and make sure your plans cover all of them.
Ask your doctors if they accept Medicare and whether they are a part of any Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO) networks.
- List out your potential medical treatment and hospitalization needs for the upcoming year.
- Consider the other insurances that you have and how they might work with or work against Medicare.
- Assess your needs for dental work, glasses, hearing aids, and other types of extra coverage.
- Evaluate your plans to travel outside of the coverage area or to a different country.
3. Who Qualifies For Medicare?
To qualify for Medicare, you must be a US citizen or a legal permanent resident for at least 5 continuous years. You also have to be at least 65 to be entitled to this health care program, but this is not a general requirement. People under 65 are also eligible for Medicare if they:
- Have disabilities and receive social security disability insurance benefits for 2 years
- Have end-stage renal disease (permanent kidney failure) and receive dialysis, or have undergone a renal transplant
- Have ALS (Lou Gehrig’s disease)
- Have a disability pension from the Railroad Retirement Board.
4. What Does Medicare Cover?
Medicare is divided into 4 parts (A, B, C, and D) to take care of all your essential medical needs. Together, the first 2 parts are called the Original Medicare and cover most basic services, while the latter 2 parts serve other purposes:
- Part A (Hospitalization) covers your hospital and treatment care related to hospital services, along with hospice care for people who are terminally ill. Those with modest incomes will not have to pay any premium, while people with higher incomes may have to pay an additional monthly fee.
- Part B (Medical) covers your general medical and outpatient care that keeps you healthy, which includes:
- The majority of preventative services
- Medical supplies and equipment
- Numerous types of tests and screenings
- Mental health services.
For this Medicare coverage, you will have to pay a premium based on your income.
- Part C (Medicare Advantage) is a provision that private insurance companies look for when providing plans for people who are enrolled in the original Medicare plan (parts A & B). This provision comes with extra coverage for a prescription drug, dental, vision, and hearing services. Depending on the type of plan you need, you may or may not have to pay a premium (usually deducted from your security check), and an additional fee like copayment or deductible is often included.
- Part D (Prescription) covers prescription drugs. The premium for this plan may vary based on your income, while the copayment and deductible will depend on the type of drugs that you need.
There is also another segment called Medigap (Medicare Supplement), which works alongside Medicare to support the out-of-pocket expenses that Medicare is not able to cover. Medigap consists of 10 different plans (A, B, C, D, F, G, K, L, M, N) and is sold by private companies, and the coverage of each plan is slightly different based on its specific details.
5. What Does Medicare Not Cover?
While Medicare provides coverage for numerous services, long-term care is not one of them. If you absolutely need custodial care, Medicare Advantage or Medigap are amongst the only plans that offer you long-term care benefits, but they are typically very limited. Moreover, Medicare does not cover the following expenses:
- Hearing aids and exams
- Glasses and eye exams
- The majority of dental services
- Foreign medical care
- Cosmetic surgery
- Massage therapy
For these healthcare services, you will have to pay the full cost if you decide to use them.
If you are already receiving social security benefits, you are automatically enrolled in the Medicare healthcare program. If you are not, contacting the social security office up to 3 months before or after your 65th birthday will make you eligible for Medicare enrollment. You can enroll through the Medicare online application on the SSA website, through the SSA hotline, or through direct application at your local Social Security Administration office. Make sure you consider all the benefits of Medicare so that you can make the best choice for yourself and your family.