Determine if You’re Eligible for Medicare Coverage

Who is Eligible for Medicare?

Medicare Eligibility Form The price of medical bills and maintaining your health can be quite overwhelming. The U.S. Government has established Medicare, a health insurance system to aid U.S. residents who meet certain criteria, in meeting the costs of their healthcare. However, being a U.S. resident over the age of 65 is not the sole requirement for receiving 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). 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 grouped similarly as part of Original Medicare, Medicare Part C is known separately as Medicare Advantage. Medicare Part D is known as Prescription Drug Coverage.

Medicare Part A:
When you enroll to receive Medicare Part A, you will basically be covered for hospital insurance. While Medicare Part A covers most necessary medical 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 health care services (part time nursing care service and equipment for ill at home). The payment of a premium is not common for Medicare Part A, especially if you or your spouse paid Medicare taxes while working. You are eligible for Part A if you meet any of the listed qualifications for Medicare.

Medicare Part B:
Medicare Part B provides coverage for some of the other medical expenses.  These include other expenses that your medical needs may require that are not covered by Medicare Part A. This can include necessary doctor services, and outpatient care (medical service that does not require overnight stay in the hospital or may not even include a hospital visit). Medicare Part B is a good choice for those with diabetes or at risk for diabetes because it covers many costs associated with diabetes including but not limited to, glucose test strips, insulin and blood sugar testing monitors. Find more details on what Medicare Part B covers regarding diabetes here. Also, Medicare Part B usually covers many necessary preventative shots (such as the flu shot or hepatitis B). However, unlike Medicare Part A, Medicare Part B requires a monthly premium. The standard monthly premium in 2017 is $134.00 a month (or higher depending on your income). However, most people who received benefits from Social Security pay less. If you qualify for Medicare Part A, you will likely qualify for Medicare Part B.

Medicare Part C:
Medicare Part C is also called Medicare Advantage. With these plans, services are performed by private companies also approved by Medicare. Medicare Part C combines the benefits of Medicare Part A and Part B and may include additional coverage for other necessary medical services like prescription drugs, hearing, and vision services. Most Medicare Advantage Plans consist of particular doctors and hospitals in an area that a person must use in order to receive coverage for the medical treatment they receive. Your out-of-pocket costs depend on many factors, like if the plan charges a monthly premium or has a yearly deductible.  Benefits, premiums, and/or member cost-share may change on January 1 of each year.   There are several Medicare Advantage Plans available to you.  These plans 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 Account (MSA), and HMO Point of Service Plans (HMOPOS).

Medicare Part D:
Medicare Part D may be added to Original Medicare. Medicare Part D covers prescription drug costs, which is done through private companies approved by Medicare. This, too, sometimes requires a premium monthly payment. To receive coverage from these private companies, you must either join a standalone Medicare Prescription Drug Plan or choose a Medicare Advantage Plan which includes Medicare Part D prescription drug coverage. Depending on the costs of your prescription drugs, you may have co-payments. If you are eligible to receive Medicare Part A or Part B, then you are eligible to receive Medicare Part D. It is likely that you will have to pay a late enrollment penalty if you decide not to sign up for Medicare prescription drug coverage when you’re first eligible.

Sources: Medicare.govMedicare&You