What Is Medicare?

US adults aged 65 and above and younger people with certain disabilities or illnesses have federal health insurance coverage known as Medicare. This health insurance program covers medical costs for these people as they age. This health insurance program is divided into four divisions, Part A, Part B, Part C, and Part D, each offering specific medical coverage with varying costs.

– Part A – caters to medical care and related services.

– Part B – It covers any doctor appointments and outpatient medical services

– Part C – This insurance covers the benefits of Part A and Part B, but it is quite different because private insurers provide it.

– Part D – It covers drug prescriptions.

Who Is Eligible for Medicare?

Any person who is 65 years old, a permanent legal resident for five years, or a US citizen is eligible for Medicare . People with certain disabilities and illnesses are also eligible for Medicare, even if they are under the age of 65 years. People benefiting from Social Security disability insurance are eligible for Medicare after their two-year waiting period. However, anyone with end-stage renal diseases or permanent kidney failures, amyotrophic lateral sclerosis, is eligible for the coverage automatically and the month this disability begins.

What Is Original Medicare?

Original Medicare refers to the Part A and Part B insurance coverage that the federal government manages. People who benefit from the Medicare insurance program can visit a hospital that accepts this coverage; the government program pays a significant part of the medical costs.

Types of Medicare Health Insurance Coverage

Medicare Part A

This hospital insurance covers inpatient care in any skilled nursing facility or hospital. However, this hospital insurance never covers long-term care or custodial care. Part A also covers hospice care and part of home health care. This insurance coverage has a deductible of $ 1556 and $ 1600 in 2022 and 2023, respectively, and coinsurance means that the patients pay part of the medical bill. For the first 60 inpatient hospital care, coinsurance is not included, but from day 61 to day 90, the hospitalized patient has to pay $ 389 and $ 400 in 2022 and 2023, respectively.

In addition, people do not pay premiums for this hospital insurance, especially if for at least ten years, you have paid all Medicare taxes . The same case applies if their spouses have been paying Medicare taxes for the same period.

Medicare Part B

This medical insurance covers doctor visits, services, and medically necessary supplies. This includes health care or preventive services meant to prevent illness, ambulance services, mental health coverage, outpatient prescription drugs, and durable medical equipment.

This medical insurance requires a $170.10 and $164.90 monthly premium in 2022 and 2023, respectively. However, the monthly premiums are higher for single people whose gross income is above $97000 and married couples filing for joint insurance with a gross income of $ 194000. The insurance comes with a deductible of $ 233 in 2022 and $ 226 in 2023. After paying a deductible, you only have to pay off the 20% Medicare insurance amount for the necessary supplies and services.

Unfortunately, Medicare Part B comes with a penalty for people who lack group health insurance from large employers and have never signed up for this medical insurance coverage at 65 years, but at some point, they decide that the coverage is important. In such a case, one is to pay a penalty of 10% of the monthly Medicare premium for every year you delay. This penalty is payable for a lifetime. This penalty is avoidable if one immediately has health insurance through their employer, partner, or spouse. In this case, one has to sign up within the eight-month the coverage ends and provide proof of group insurance after one turns 65 years of age.

Medicare Part C

Medicare Part C coverage is also known as the Medicare Advantage. It is a health plan provided by private insurance companies offering both Part A, Part B, and Part D. As you benefit from this health plan, you are needed to continue paying your medical insurance or Medicare Part B premium. Your insurance might ask you to pay a separate premium. However, most Medicare Advantage plans are available at $ 0 premiums to insured persons. Some cost benefits for dental, visual, and vision care are provided as additional coverage by this medical plan. Unlike the Original Medicare, this plan comes with an annual limit on out-of-pocket costs. The out-of-pocket limit in 2022and 2023, respectively, is $7550 and $ 8300.

Medicare Part D

This medical insurance caters to the costs of prescription drugs with brand names or generic drugs. The plan is provided by private insurance, and an average monthly premium of $33 is charged to the insured. However, people with a higher income pay more than this amount.

Like Part B, this insurance plan also comes with a penalty for anyone who needs to sign up when they are first eligible for the coverage. One has to pay a 1% penalty of the national base beneficiary premium which may add up to $33.37 monthly. The penalty has to be paid for the number of months you were eligible for the medical plant but ended up enrolling late.

What Is Medigap?

This is also known as Medicare Supplement Insurance and is an extra health insurance policy one can buy from private insurers to cater for one’s medical costs that medicare Part A and Part B do not cover. It includes coinsurance, deductibles, and some health care, especially if you travel outside the country where this Medigap plan does not cover prescription drugs, private nursing care, long-term care, vision, dental care, and hearing aids. However, there is always a catch when it comes to Medigap plans since you cannot purchase the policy if you do not have both Medicare Part A and Part B.

How to Enroll in Medicare

You automatically enroll for Medicare Part A and Part B when you receive Social Security benefits when you turn 65. However, if you need Medicare Part D, you will have to enroll yourself personally. On the other hand, if you are among those without Social Security benefits, you will need to sign up for this medical plan through the social security administration website.

You must sign up for the medical plan around the seven months window of your 65 birthday, which starts on your birthday month and three months after turning 65. This will help you avoid any penalties and delays for your insurance policy to be active. If you want Medicare Supplement insurance, you need to sign up during the six-month Medigap enrollment period that starts on your birthday month you turn 65 and have a Medicare Part B.

Which are the medicare enrollment periods

Enrolling for Medicare Part A and Part B is automatically done when someone turns 65, especially if you qualify due to disability or illness or have claimed social security benefits. Apart from such instances, you have to enroll yourself during the following enrollment periods;

Initial enrollment periods

This is an enrollment period for people who are not automatically enrolled in the plan. This period lasts seven months when you turn 65, three months before turning 65, your birthday month, and three months after turning 65. If you turn 65 on the day one of any month, your enrollment period will be four months before turning 65 and two months after your birthday.

General enrollment period

This enrollment period applies to anyone who does not apply for the medical plan during the initial enrollment period. It runs from 1st January to 31st March every year, while its coverage starts on 1st July.

Special Enrollment period

This period is when one can join Medicare or make any coverage changes based on specific life events like leaving a job or moving out of an area your plan covers.

What Medical Expenses Does Medicare Not Cover?

The following are expenses that Medicare will not cover;

– Dentures

– Eye exams and eyeglasses

– Most dental care

– Cosmetic surgery

– Medical care overseas

– Most foot care, unless it is as a result of diabetes, injury, or disease

– Massage therapy

– Hearing aids and exams to fit them