Medicare is a program that provides health insurance to millions of people in the United States. It’s funded by taxes and premiums, and it’s administered by the federal government. There are four parts:

• Part A: This covers hospital stays, skilled nursing facilities, hospice care, and home health care.
• Part B: This covers doctor visits, outpatient care, and preventative services.
• Part C (Advantage Plan): This offered by private insurance companies as an alternative to the Original Plan (Part A and Part B).
• Part D: This covers prescription drugs.

 

Who is Eligible?

Generally, people are eligible if they’re 65 or older and they or their spouse have paid into the system through payroll taxes for at least 10 years. People who are under 65 may also be eligible if they have certain disabilities or medical conditions, such as end-stage renal disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS).

 

Why Medicare is Important?

This is a vital program as it provides access to healthcare for millions of Americans, particularly those who might not be able to afford health insurance otherwise. Without the program, many seniors and people with disabilities would have to pay for their medical expenses out of pocket, which could be financially devastating.

 

History and Recent Changes

Medicare was signed into law in 1965 as part of President Lyndon B. Johnson’s Great Society program. Since then, it has become one of the country’s most popular and successful social programs. In recent years, there have been some changes to the program, including the Affordable Care Act (ACA), which added preventative services and closed the “donut hole” in the prescription drug benefit.

 

Types of Plans: Original Medicare, Medicare Advantage, and Medigap

There are three main types of plans: Original Medicare (Part A and Part B), Medicare Advantage (Part C), and Medigap (Supplemental Insurance).

 

Original: Parts A and B

Original Medicare is the traditional fee-for-service health insurance program offered by the federal government. It covers hospital stays, doctor visits, and other healthcare services.

 

Advantage: Part C

Medicare Advantage is an alternative to the Original plan that’s offered by private insurance companies. These plans often include extra benefits like vision, dental, and hearing coverage.

 

Medigap (Supplemental Insurance): Part D

Medigap is a type of supplemental insurance that can be purchased to help pay for things that the Original plan doesn’t cover, like deductibles and coinsurance.

 

Comparing Plans and Choosing the Right One

It’s important to compare Medicare plans and choose the right one for your needs. Factors to consider include cost, coverage, and network of doctors and hospitals.

 

Enrollment and Eligibility: How to Sign Up and When to Enroll

When to Enroll

Most people become eligible for Medicare when they turn 65. If you’re not already receiving Social Security benefits, you can sign up for Medicare during the 7-month period starting 3 months before your 65th birthday.

 

How to Enroll

You can enroll online, by phone, or in person at your local Social Security office.

 

Common Enrollment Mistakes to Avoid

Common enrollment mistakes include missing deadlines, failing to sign up for Part B when you’re first eligible, and not understanding the coverage options available to you.

 

Special Enrollment Situations

There are special enrollment situations that allow you to sign up for Medicare outside of the initial enrollment period, such as if you move to a new area or lose your job-based health coverage.

 

Coverages and Benefits

What Medicare Part A Covers

Medicare Part A covers inpatient hospital care, hospice care, and limited skilled nursing facility care.

 

What Medicare Part B Covers

Medicare Part B covers doctor visits, outpatient care, and preventative services such as flu shots and screenings.

 

What Medicare Part C Covers

Medicare Part C (Medicare Advantage) covers everything that Original Medicare covers, plus extra benefits like vision, dental, and hearing coverage.

 

What Medicare Part D Covers

Medicare Part D covers prescription drugs.

 

What Isn’t Covered

Medicare doesn’t cover everything, including long-term care, most dental care, and hearing aids. It’s important to understand what’s covered and what’s not covered, so you can plan accordingly.

 

How Medicaid and Medicare Work Together

Some individuals are eligible for both Medicaid and Medicare, known as dual-eligibles. In these cases, Medicaid can help pay for services that Medicare does not cover, such as long-term care.