Medicare came into existence in 1966 under the Social Security Administration as the first national health insurance program provided to older U.S. citizens by the government. Currently, the federal government now administers it through the Centers for Medicare and Medicaid Services.
Medicare primarily serves people 65 years of age and older, as well as people with certain disabilities. Though run under the same agency, it’s important to note that Medicare is a separate program from Medicaid, which helps low-income people of every age to cover medical and other expenses. In this article, we’ll explore the basics of Medicare and what each part covers to better prepare you for your transition to Medicare coverage.
Who is Eligible to Enroll?
Medicare eligibility is guaranteed for U.S. citizens who are 65 or older, as well as those who have been a permanent legal resident for at least the past five years. Medicare also includes certain people with disabilities who are under the age of 65. People who receive Social Security benefits or Railroad Retirement Board disability become qualified for Medicare after a 24-month waiting period. People with conditions such as permanent kidney failure, kidney transplants, or amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig’s disease) can become eligible for benefits immediately.
Keep in mind these are just general guidelines, and your situation may be different. If you’re still unclear about who is eligible for Medicare, Anthem is a great resource where you can get information and enroll as quickly as possible to start receiving health coverage.
When to Apply for Medicare
The best advice is to make sure that you apply for Medicare within the eligibility window, which begins three months before your 65th birthday, includes your birthday month, and extends to the three months following your birthday. Remember, these enrollment guidelines refer to Medicare Part A, Part B, and supplemental coverage such as Medigap and Medicare Advantage. Keep in mind private, Medicare-approved insurers are the agencies that provide supplemental coverage options and are required to ensure you as long as you don’t miss the aforementioned seven month eligibility period. Otherwise, they can deny your request for coverage.
You will be automatically enrolled in Medicare Part A and Part B as long as you are receiving Social Security benefits. If you are not receiving any Social Security benefits, you must enroll on your own to guarantee coverage.
What Coverage Should I Choose?
No one coverage option provides the perfect solution for every person’s medical needs; instead, you should choose based upon your specific health coverage requirements. So, below is a brief overview of what each Medicare part covers to give you a better idea of which might be right for you.
Medicare Part A
Also known as Original Medicare, Medicare Part A covers hospital stays, hospice care, and some skilled nursing care. While Medicare Part A may not charge a monthly premium, it does have a deductible.
Medicare Part B
Medicare Part B’s coverage includes doctor visits, lab tests, diagnostic screenings, medical equipment, ambulance transportation, and other outpatient services. With Medicare Part B coverage, you’re charged a monthly premium and an annual deductible.
Medicare Part C
Otherwise known as Medicare Advantage, these plans are only offered through private, Medicare-approved insurers. These comprehensive plans not only provide all the benefits of Parts A and B but also usually provide coverage for dental, vision, and hearing services as well as prescription drug benefits.
Medicare Part D
Medicare Part D provides prescription drug cost coverage and usually comes with some type of premium and additional out-of-pocket-costs. If you have extremely costly prescription drug bills, you may be subject to the Medicare coverage gap.
Make the Transition to Medicare Smooth
Retirement and applying for Medicare often go hand in hand. If that’s the case, it’s important to understand that this period in your life or the life of your loved one can be emotionally trying. A useful way to navigate these impactful changes is to find a trusted advisor. He or she can walk alongside you to make sure you have all the Medicare information you need to make the best choices for your long-term health and happiness.