More than 45 million Americans are covered by Medicare, the nation’s largest health care program. But many people don’t understand the eligibility requirements and benefits involved with this federal coverage. This article strives to clarify some of the issues surrounding this important health care issue that affects so many seniors.
There are several requirements that must be met before an individual is eligible for Medicare. An individual must be a United States citizen or at least have been a permanent legal resident for five years. Individuals who have reached the age of 65 years old are automatically eligible for Medicare benefits. There are some citizens who qualify before they reach age 65. These people have a diagnosis of End Stage Renal Disease or Lou Gehrig’s disease. Those who are permanently disabled with other chronic health conditions and have received Social Security disability for at least two years also qualify.
There are several types of Medicare coverage. This is a confusing area for many people but it isn’t really that complex. Medicare Part A provides hospital coverage. This portion of Medicare does not require the payment of a premium. Medicare Part B provides medical insurance benefits. This portion of Medicare requires recipients to pay a premium. Medicare Part C is also known as Medicare Advantage and is administered by private health plans. This option combines the benefits of Medicare Part A, Medicare Part B, and prescription drug coverage. Additional wellness, vision and dental benefits may also be included in these plans. Medicare Part D offers prescription drug insurance. This portion of the Medicare program became effective in 2006. Additional premiums are required to maintain this portion of Medicare.
Medicare Part A covers care administered by skilled nursing care facilities, home health, and hospice. These services must be deemed medically necessary. There is a deductible associated with these services. Medicare Part B pays for the services of physicians, outpatient services, lab tests, x-rays, medical equipment, select preventative services, mental health services, and ambulance fees. There is an annual deductible and a co-pay associated with this part of Medicare. Medicare Part C (also known as Medicare Advantage) has varying premiums, deductibles, and co-pays. This form of Medicare operates much like a traditional HMO. Medicare Part D is administered by private providers like Medicare Part C. There is financial assistance available for individuals who need help with paying Medicare Part D premiums.
Medicare Advantage is gaining popularity among seniors but there are special considerations that consumers need to be aware of. Seniors need to fully understand the coverage included in a plan before making a purchase. Not all doctors accept this form of Medicare. Consumers need to understand required deductibles, out-of-pocket expenses, and co-payments. It’s critical to determine if coverage extends to out-of-state providers if seniors travel frequently. A consultation with a Medicare counselor may be a wise decision before enrolling in a Medicare Advantage plan.
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