Medicare
What Is Medicare?
Medicare is a national health insurance program created by the U.S. government to ensure that older adults and certain individuals with disabilities have access to affordable healthcare. It primarily serves people who are 65 years or older, but it also covers individuals under 65 who have specific disabilities or serious health conditions, such as End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS). Medicare helps cover a wide range of medical services, from hospital stays to doctor visits and prescription medications.The Parts of Medicare
Medicare is made up of different parts that each focus on specific healthcare services. Understanding these parts is key to choosing the right coverage for your needs:- Part A (Hospital Insurance): Helps pay for inpatient hospital care, skilled nursing facility stays, hospice care, and some types of home health care. Most people don’t pay a premium for Part A if they or their spouse paid Medicare taxes while working.
- Part B (Medical Insurance): Covers outpatient care, doctor visits, preventive services, durable medical equipment (like wheelchairs), lab tests, and mental health services. Part B typically comes with a monthly premium, which may vary based on income.
- Part C (Medicare Advantage): Offered by private insurance companies approved by Medicare, Part C bundles Part A and B (and often Part D) into one plan. These plans often include extra benefits like dental, vision, hearing, transportation, and even fitness programs. Many Medicare Advantage plans have low or no premiums beyond what you already pay for Part B.
- Part D (Prescription Drug Coverage): Helps cover the cost of prescription medications. These plans are available as standalone coverage (if you’re on Original Medicare) or may be included in a Medicare Advantage plan. Part D plans vary in cost and coverage, so it’s important to compare options based on the medications you need.
Who Is Eligible for Medicare?
You’re generally eligible for Medicare if you meet one of the following criteria:- You’re 65 years or older and a U.S. citizen or permanent legal resident who has lived in the U.S. for at least five consecutive years.
- You’re under 65 but have received Social Security Disability Insurance (SSDI) for at least 24 months.
- You have been diagnosed with ALS (Lou Gehrig’s Disease), in which case you qualify for Medicare immediately after starting SSDI benefits.
- You have ESRD (End-Stage Renal Disease) and meet specific requirements, such as needing regular dialysis or a kidney transplant.
When Can You Enroll?
There are several key times during the year when you can enroll in Medicare:- Initial Enrollment Period (IEP): Starts three months before the month you turn 65, includes your birthday month, and continues for three months after — a total of 7 months. This is the best time to enroll to avoid penalties and gaps in coverage.
- General Enrollment Period (GEP): If you missed your IEP, you can sign up between January 1 and March 31 each year. However, your coverage will begin on July 1 and you may face a late enrollment penalty.
- Open Enrollment Period: Runs from October 15 to December 7 each year. During this time, you can switch between Medicare Advantage and Original Medicare, change Medicare Advantage plans, or add/drop Part D coverage. Your changes take effect January 1.
- Special Enrollment Period (SEP): You may qualify for SEP if you’ve experienced specific life events, such as losing employer coverage, moving to a new area, or qualifying for Medicaid or Extra Help.
