Who is eligible for Medicare

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Medicare is a federally-administered social insurance program that provides health insurance coverage for older people and people with specific disabilities. Medicare is funded jointly by the federal government and its middle-income households through payroll taxes. It provides coverage for inpatient hospitals, skilled nursing facilities, hospice and home health care, and other medical services. The program is funded mainly through the payroll taxes paid by workers and employers.

Requirements to Qualify For Medicare Benefits
• – You must be at least 65 years of age on the day before the first day of your first month of retirement, or you must have already retired and reached age 65 in a month during which you were entitled to receive retirement benefits under a previous Social Security program.

• – You must be disabled as defined by Social Security Administration policy. Your disability must also meet the definition used by your employer’s private insurer or the Railroad Retirement Board.

• – You must be either a U.S. citizen or a permanent resident alien with a green card, living in the United States and not residing in an institution such as a hospital or nursing home. Individuals without this status may be eligible for Medicare if they have lived lawfully in the United States for five or more consecutive years (the “5-year rule”), are disabled, have end-stage renal disease, or have ALS.

• – You must have the same Medicare-eligible medical conditions covered under your employer-sponsored coverage or coverage under Social Security. If you participated in a group health plan, you must have the same health problems that protected you from discharge from employment.

• – You must have paid Medicare payroll taxes for at least ten years. Individuals younger than 65 who don’t have the required ten years of coverage may still be covered under tightly-restricted conditions.

• – You must purchase Medicare Part B Medical Insurance regardless of age, health status, or medical condition. If a person qualifies for premium-free Part A, they are also unable to purchase Part B.

Types of Medicare Plans
1. Medicare Part A – Hospital Insurance
Medicare Part A is the most common and basic type of Medicare coverage. It covers inpatient hospital stays at an inpatient hospital facility, skilled nursing facilities, hospice care, home health care, and ambulance services. Part A also covers a limited amount of durable medical equipment and supplies (DME), such as wheelchairs, walkers, and hospital beds, for use in your home. Medicare Part A is available to individuals aged 65 or older, permanently disabled, or eligible for Social Security Disability Insurance (SSDI) benefits.

2. Medicare Part B – Medical Insurance
Part B covers various medical services and supplies, including physicians’ services, home health care, and outpatient hospital services. Medicare Part B also pays for a limited amount of DME in the home. For most people, Part B premiums are deducted from their income or Social Security benefits if they are eligible or have earned Social Security Disability Insurance (SSDI) benefits if they are not otherwise eligible for Part A. Medicare Part B is available to all people age 65 or older and specific individuals under the age of 65 with certain medical conditions.

3. Medicare Advantage Plans (Medicare Part C)
Medicare Advantage plans are health plans that offer coverage similar to the kinds of benefits provided under both Parts A and B of Original Medicare. Still, there may be a few different rules for eligibility and benefits, which you should carefully review before enrolling in a plan. These plans may have extra benefits that traditional Medicare does not have. You should also be aware that Medicare Advantage Plans (Part C) typically have higher out-of-pocket costs than Original Medicare.

4. Prescription Drug Coverage (Medicare Part D)
Medicare Part D covers most prescription drugs but has a yearly deductible and may have other costs you must pay when you get your prescriptions filled at a pharmacy. There are many different Medicare Prescription Drug Plans (Part D) that you may choose from, and you may enroll in a stand-alone prescription drug plan or one that is combined with a Medicare Advantage (Part C) plan of your choice.

Advantages of Having a Medicare Plan
1. Access to Private Health Insurance
If you have a private health insurance policy that covers you and your family, you can choose to keep it. However, suppose you enroll in a Medicare Advantage plan (Part C). In that case, your current health insurance may not cover differences between the coverage under Original Medicare (Parts A & B) and the plan’s benefits.

2. Additional Benefits
Medicare Advantage plans (Part C) often provide additional benefits unavailable under Original Medicare (Parts A & B). These may include vision and dental, wellness, and prescription drug coverage.

3. Lower Out-of-Pocket Costs
Medicare Advantage plans may have lower out-of-pocket costs than the cost of Original Medicare (Parts A & B). However, you should carefully compare both options’ costs to determine which is more affordable.

4. Additional Medicare Rights
If you are enrolled in a Medicare Advantage (Part C) or stand-alone prescription drug plan, you have additional rights, such as signing up for retroactive drug coverage when you get a new prescription. It means that any expenses incurred after the date of your last Part D enrollment are covered retroactively. However, if you are not enrolled in a plan, there is no automatic right to receive retroactive coverage. You may have to contact your insurer and ask for this benefit.

5. Prescription Drug Discount Cards
Some Medicare Advantage (Part C) plans offer discounts on prescription drugs for enrollees. Still, some plans do not provide these discounts because they do not want to pay for the administrative costs and other fees associated with offering this benefit. However, if your plan offers this benefit, you may be eligible for a discount on prescription drugs at thousands of participating pharmacies nationwide.

Disadvantages of Having a Medicare Plan
1. Deductible and Coinsurance
Medicare Advantage plans (Part C) usually have deductibles and coinsurance, meaning you must pay a certain amount out of your pocket before the plan pays anything toward your medical expenses. Also, you will usually have higher out-of-pocket costs if you receive your prescription drugs from a Medicare plan than when you get them through private insurance.

2. Access to Covered Services
If you are enrolled in a Medicare Advantage (Part C) plan, the plan’s network of doctors and hospitals may not include many providers. It could cause problems when trying to schedule needed treatments and diagnostic services.

3. Out-of-Network Coverage
Receive your medical services from an out-of-network provider. Your Medicare Advantage (Part C) plan may not pay anything until you pay a more significant portion of the bill. You may have to pay the entire cost out of pocket.

It is in your best interest to discuss the benefits, costs, and alternatives of Traditional Medicare (Parts A & B) with your doctor and other health care professionals before enrolling in any Medicare plan. It may ensure that you have the necessary medical coverage for your family if you need it in an emergency.

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