Medicare Explained

Everyone has unique medical needs, which can be complex for us when considering our health-related requirements. With the help of Medicare, you can expect flexibility within the insurance plan that you choose. Different from Medicaid, you can register for Medicare when you are 65 and older. However, some individuals that have certain disabilities may qualify.

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Medicare was designed to be both reliable and cost-effective, where you can expect a variety of different options to choose from. You can discover more information about Medicare to see if it the right route for you.

Overview of Medicare

When you choose Medicare, you must learn more about it to decide what enrollment plans work for you. Once you’ve enrolled, you can enjoy many of the benefits.

Medicare Eligibility

You might not qualify for the Medicare healthcare program if you are not 65 and older. Most individuals 65 and up may be automatically enrolled if they have Social Security. It is also a requirement that you must be a U.S. citizen. The other alternative is to be a legal permanent resident for over five years. If you do not fit the requirement of being over 65, you might be eligible if you have a disability. This disability would need to be checked out, proven, and fit within the legal boundaries of federal requirements for what would be defined as disabled.

If you currently are receiving Social Security disability insurance, you have to wait a two-year period before enrolling. There is a shorter waiting period for enrollment if you have amyotrophic lateral sclerosis or end-stage renal disease.

The Enrollment Process

When you are enrolled in the Social Security benefits program at the age of 65, you will be automatically enrolled into Medicare Part A or Part B. For clarity, the difference between both programs is that Part A provides coverage for hospitals you attend for overnight visits and Part B provides outpatient coverage for treatments from doctors and medical practitioners. Medicare Part D enrollees can receive prescription drug coverage for most brand name and generic medicine. Part D enrollment is not automatic, however. If you are not auto-enrolled, you will have to near your 65th birthday so that you do not get charged with penalty fees. Late fees begin three months after your birthday, but you can enroll within a 7 month period.

If you want to receive Medicare Supplemental Insurance (Medigap) to cover any items that you are not receiving under Medicare, you will need to sign up during the 6 month enrollment period. This opens up the same month you have turned 65.

Original Medicare

The original Medicare program includes Part A and Part B plans. You only have to pay out of pocket after you get treatment. The deductible must be paid at the beginning of every benefit period.

Typically, a deductible is 20% of the service you signed up for. Medicare will cover a majority of the healthcare services and prescriptions that you require. However, if you are unable to obtain the full service you need, you can also add on a Medigap policy. These policies help to cover copayments, coinsurance, deductibles, and a plethora of other medical costs that your Medicare programs may not cover. Some Medigap policies have the ability to cover treatment when you travel internationally as well.

Medicare Advantage Options

For those that need a little more flexibility, Medicare can bundle Part A, Part B, and Part D. Unlike Medicare, you can receive additional add-ons unique to this program. There are hearing, dental, and vision programs as well as other options you may need. The Medicare Advantage plan is offered through private insurers. However, they must be compliant with government regulations to provide these plans. There is great variety across these Medicare Advantage insurance plans because each private insurer has its own approach to designing program options.

For this reason, you will notice that there are different out-of-pocket costs across the services you may be considering. This means that you may expect to pay more out-of-pocket than you would for Medicare programs.

Original Medicare Coverage

When you are enrolled with Medicare, you can visit any doctor or hospital that is part of the Medicare program. If the facility or doctor is accepting new patients and also registered with Medicare, you have the opportunity to use their services. There is no requirement for you to be referred to a specialist, and you do not need a primary care doctor. Any specialist you decide to work with only needs to be enrolled in Medicare. You would need to pay a deductible amount for Medicare, and for any additional service, you would pay a copayment or coinsurance fee. Both Part A and Part B have no annual limit. Part B has a monthly premium, and Part A is often free if you have been paying social security benefits in previous employment history. This coverage plan does not include prescription drugs, so you would need to enroll in Part D to receive the medicine you need.

In some instances, you may not need part D because you have coverage under your union. If you are employed full-time with benefits, check with your employer to see if there is any insurance coverage that may provide you with prescription drugs. If there are any services that you are not receiving, you can enroll in Medigap to help with that.

Medicare Advantage Plan Coverage

Through a private insurer, you can obtain this coverage plan which is also called Part C. This plan is regulated by the government and must meet requirements for a private insurer to qualify. The Part D coverage can be incorporated into Part C for greater convenience. In this program, you have to attend a healthcare provider in the network local to your region. You can’t attend facilities or doctors outside of your region without losing your coverage. It is better to pick a low-cost service so you have fewer out-of-pocket fees to pay when you are using Medicare Advantage. When you use a doctor or healthcare service outside of your network coverage, the price will be more expensive for you even if the facility or practitioner is part of the Medicare program.

This program is better for someone who wants some medical coverage but doesn’t use it very often. You can always switch back to the Original Medicare plan if you wish to have greater coverage when you require more frequent medical treatments.

Learn More About Your Medicare Program

To discover more information on Medicare options, speak with a professional who can educate you on the benefits of Medicare plan enrollment. These individuals will explain to you what each plan offers. They can go through your special requirements and suggest which program would fit within your budget goals. Contact a dependable representative today who can guide you.


How Original Medicare works
Medicare Advantage Plans
Your Health Insurance Coverage


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