As one can expect from such a large program, Medicare can be quite complex and loaded with details, restrictions, conditions and terms.
We’re here to cut through the fine print and outline the basics of Medicare coverage in a clear and easy-to-understand way.
Medicare is a federal health insurance program for seniors and some younger people who have certain disabilities or conditions. The program is primarily funded by Medicare payroll taxes.
Medicare covers a wide range of medical services, treatments, preventive care and medical devices. Everything from a routine physical examination to certain surgeries to certain prescription drugs may be covered by Medicare.
You may download a free copy of Medicare & You 2019, which details what is covered by Medicare.
In order to be eligible for Medicare, you must be at least 65 years old and a U.S. citizen (or a permanent legal resident for at least five years).
If you can check both of those off the list and have paid sufficient Medicare taxes while working, you may get the added bonus of not having to pay a premium for Medicare Part A (we’ll explain more about the different parts of Medicare below).
There are some circumstances under which you could potentially qualify for Medicare if you are under the age of 65. If you have been collecting disability benefits from Social Security or the Railroad Retirement Board for two years, you can qualify for Medicare regardless of your age.
You can also qualify if you have kidney failure (End Stage Renal Disease, or ESRD) or ALS (Lou Gehrig’s disease).
Medicare is made up of four main parts.
Many Medicare beneficiaries may also have the option of enrolling in a Medicare Supplement Insurance plan, also called Medigap.
These optional plans don’t offer coverage for medical services, but they can help pay for some of the Medicare deductibles, coinsurance and other out-of-pocket expenses that Medicare beneficiaries may incur.
Medicare Advantage plans, Medicare Part D plans and Medigap plans are sold by private insurance companies. Plan availability, benefits and costs may vary.
There are three main types of expenses associated with Medicare.
Medicare is accepted all over the U.S. and U.S. territories.
Medicare Part A, Part B and Medigap plans are accepted by the majority of health care providers.
Part C and Part D plans typically include networks of participating providers who accept the plan's terms and conditions.
There are certain times of the year in which you may sign up for Medicare coverage, and the different parts of Medicare each have their own timelines and rules for enrolling.
If you don't enroll in Medicare Part B or Part D when you first become eligible, you may be subject to late enrollment penalties.
For help with enrolling in Part A or Part B, you can contact the Social Security Administration.
To get more information on Medicare Advantage plans and benefits that may be available in your area, call to speak with a licensed insurance agent today.
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