Administered by the CMS, (Centers for Medicare & Medicaid Services), the Medicare system has parts that seek to protect the well-being and health of elderly Americans. It was designed to address the concerns about the affordability of healthcare in the United States for them. According to the Research Data Assistance Center, Medicare has provided millions of Americans access to much needed affordable and quality healthcare. Many people, however, are still unaware of how Medicare can help improve their quality of life after retirement, much less the Medicare parts.
You qualify for Medicare benefits if:
- You are 65 years or older
- You are under 65 years of age but receive Social Security disability benefits or the Railroad Retirement Board (RRB) benefits
- You have ALS (amyotrophic lateral sclerosis)
- You have end-stage renal disease (ESRD)
There are four main Medicare parts; Part A through D. We will zoom in on these specific parts of the government health insurance program. The aim is to help you understand the basics of the Medicare parts so that you can be able to decide on the Medicare coverage that suits your specific needs.
Medicare Part A
Part A covers hospital insurance. If you are hospitalized or enlist the services of home health care, Part A foots your bill to a certain level. It also extends to the services of skilled nursing facilities and hospice care. It does not cover doctor’s fees. Part A does not offer full health care coverage and so relying on it alone can be dangerous. You should enroll for Part A and B at the same time.
You are eligible for Part A if you meet any of the already mentioned conditions. You will be automatically signed into Part A once you hit 65 years. Typically, Social Security mails you your Medicare card three months before your 65th birthday. If you qualify for the disability benefits, you get the card in your mail on your 25th month of disability. After you get the card, you do not have to do anything else to keep your coverage. There would be no monthly premium with Medicare Part A if either you or your spouse paid your Medicare taxes while you were working.
However, some people may need to sign themselves up for Part A. If your circumstances do not meet the criteria, or if you have ESRD, you will need to enroll yourself through the SSA (Social Security Administration) or the RRB. You can find the SSA or the RRB through their websites. There, you get to speak to a representative who answers your questions and enrolls you.
Medicare Part B
Part B is the coverage for doctor visits, preventive services, necessary medical supplies and other services. It is also referred to as the medical insurance because it covers regular health care needs and includes things like surgeries and wheelchairs. Like with Part A, if you meet the already mentioned criterion, you qualify for Part B. In fact, you are usually auto-enrolled to both Part A and B, but you can opt out of Part B although it is not advisable. The two Medicare parts together are referred to as original Medicare.
The card you receive in your mail three months before your 65th birthday or on your 25th month of disability is suitable for both Part A and Part B coverage. The difference between the two is that while Part A is free, Part B requires you to pay a monthly premium. As of this year, the amount is $134 if you signed up on time. For people who have higher incomes, the amount is higher while it is significantly low for people who receive Social Security benefits.
The general period of enrollment for Part B is generally between January 1st and March 31st of every year. If you do not apply for Part B during this time or if you drop your coverage for some reason, you can sign up for the next enrollment period. However, if you fail to enroll between the three-month period, you will be charged a premium penalty which you pay throughout the time you have the Part B coverage. It is advisable to enroll when you first become eligible.
Medicare Part C
Also called the Medicare Advantage, Part C is another way to enjoy the benefits of Medicare parts A and B. Private companies that work collaboratively with Medicare offer the policy. The only service that part C does not cover in hospice care. Part C has plans that include special needs, accounts for medical savings, health maintenance organizations, and policies for private fee services. If you sign up for the Medicare Advantage plan, they cover your costs through the policy and not the original Medicare.
Any person eligible for Parts A and B is also qualified for C, but you must also be:
- Living in the plan’s service area
- Free of ESRD
- A U.S citizen or living there lawfully.
You can sign up for Part C when you turn 65 or when you enroll for Social Security. This time is known as the initial enrollment period. If you fail to sign up then, you can register any time between the 15th of October and 7th December of every year. Each part C plan is charged differently although some packages have no premium in addition to what you are already paying for part B. Some policies also cover Part D prescription drugs.
Medicare Part D
Part D is coverage for prescription drugs. You can sign up for Part D to supplement your original Medicare cover. Alternatively, you can get all your Medicare coverage through the Part C prescriptions plan. Whichever you choose, you want to make sure that it covers your medications. Every prescriptions plan comes with a list of drugs it covers so be careful to look at this list before settling. Note that the list may change at any time, but you will always receive a notification when they do.
Part D requires that most beneficiaries pay a premium. There are also copayments and coinsurance charges involved. While Part D is optional, if you do not enroll when you are eligible, you could have to pay penalties when you later decide to take it.
If you are new to Medicare and trying to decide which part fits your financial and health needs, you need to understand the basics to make the right decision. There are various Medicare Parts and comparing each can save you a lot in the days to come.