Medicare Eligibility and How to Enroll
Determine if You’re Eligible for Medicare Coverage
Who is Eligible for Medicare?
Which Medicare Plan Are You Eligible For?
The price of medical bills and maintaining your health can be overwhelming. The U.S. government established Medicare, a health insurance system, to help U.S. residents who meet certain criteria meet the costs of their healthcare. However, being a U.S. resident aged 65 or older is not the sole requirement to qualify for Medicare.
You may also be eligible for Medicare benefits if you are under the age of 65 and have certain disabilities or if you have End-Stage Renal Disease (ESRD) or amyotrophic lateral sclerosis (ALS, commonly referred to as Lou Gehrig’s disease). Since most people have different medical and financial needs, it is important to pick the health insurance plan that works best for you.
Which Medicare Plan Are You Eligible For?
While Medicare Parts A and B are usually grouped together (commonly referred to as Original Medicare), Medicare Part C is known separately as Medicare Advantage (MA). Medicare Part D is known as Medicare Prescription Drug Coverage.
Medicare Part A
Medicare Part A is commonly referred to as Medicare hospital insurance. Although Part A covers most necessary hospital services, it does not cover all expenses. The medical expenses covered by Medicare Part A include inpatient care in hospitals, blood transfusions (units of blood received at the hospital), skilled nursing facility care (brief period care at a facility or at a nursing home after medical treatment in the hospital), hospice care (at-home support services for terminally ill patients), and home healthcare services (part-time nursing care and equipment you receive in your home to treat an injury or illness).
Most beneficiaries receive Medicare Part A without paying a premium. The main requirement is you or your spouse having paid Medicare taxes for 10 years. You are eligible for Part A if you meet any of the listed qualifications for Medicare.
Medicare Part B
Medicare Part B is commonly referred to as Medicare medical insurance. This includes necessary doctor services and outpatient care (medical service that does not require an overnight stay in the hospital and/or require a hospital visit). Medicare Part B covers a wide variety of services typically received in a doctor’s office, including care for chronic illnesses such as diabetes and high blood pressure, as well as many preventive screenings and services, such as flu shots.
Unlike Part A, Medicare Part B requires a monthly premium. The standard premium in 2020 is $144.60 per month, but it may be higher depending on your income. Most people who receive Social Security benefits pay less.
Medicare Part C
Medicare Part C is also known as Medicare Advantage (MA). These plans resemble common employer-sponsored health insurance plans, such as HMO and PPO plans. With MA plans, services are performed by private companies approved by Medicare. Part C must include all of the benefits provided by Original Medicare, but MA plans may also include other services, such as prescription drugs, hearing, and vision services.
Most MA plans consist of specific doctors and hospitals in an area that you must use in order to receive coverage for medical treatment. Your out-of-pocket costs depend on a number of factors, such as whether the plan charges a monthly premium or yearly deductible. Benefits, premiums, and member cost-share may change each year on January 1.
There are several Medicare Advantage Plans available. Options include Medicare Health Maintenance Organizations (HMO), Medicare Preferred Provider Organization Plans (PPO), Medicare Private Fee-for-Service Plans (PFFS), Special Needs Plans (SNP), Medicare Medical Savings Accounts (MSA), and HMO Point-of-Service Plans (HMOPOS).
Medicare Part D
Medicare Part D, also known as Medicare Prescription Drug Plans, may be added to Original Medicare. Part D covers prescription drug costs, with plans offered by private insurance companies approved by Medicare. These plans require a monthly premium.
To receive Part D coverage, you must join either a standalone Part D plan or choose a Medicare Advantage Plan that includes prescription drug coverage. Depending on the costs of your prescriptions, you may have a co-payment.
If you are eligible for Original Medicare, you are eligible for Part D. If you delay enrolling in a Part D plan when you are first eligible, you will likely have a late enrollment penalty.
