 | Facts About Medicare By: Paul Lorrah Medicare open enrollment ends December 7th. If you haven't signed up yet because you're not sure of the facts, our experts will give you some Medicare insight in this article. |
What Is Medicare?
For those of you don't know what Medicare is, basically it is our country’s health insurance program for people age 65 or older and people younger than age 65 with certain disabilities [see below]. Medicare is a government program that pays the costs for hospital care, medications, rehabilitation services and to a small degree temporary short term nursing home care [see below for more details on the nursing home coverage]. Each of the above mentioned coverage fall under different parts of Medicare.
For those of you don't know what Medicare is, basically it is our country’s health insurance program for people age 65 or older and people younger than age 65 with certain disabilities [see below]. Medicare is a government program that pays the costs for hospital care, medications, rehabilitation services and to a small degree temporary short term nursing home care [see below for more details on the nursing home coverage]. Each of the above mentioned coverage fall under different parts of Medicare.
Who can qualify for Medicare?
People age 65 or older, who are citizens or permanent residents of the United States, are eligible for Medicare Part A. You’re eligible for “Part A” at no cost at age 65 if:
• You receive or are eligible to receive Social Security benefits; or
• You receive or are eligible to receive railroad retirement benefits; or
• Your spouse (living or deceased, including divorced spouses) receives or is eligible to receive Social Security or railroad retirement benefits; or
• You or your spouse worked long enough in a government job through which you paid Medicare taxes; or
• You are the dependent parent of a fully insured deceased child.
If you don’t meet these requirements, you may be able to get Medicare Part A by paying a monthly premium. Usually, you can purchase this coverage only during designated enrollment periods.
People age 65 or older, who are citizens or permanent residents of the United States, are eligible for Medicare Part A. You’re eligible for “Part A” at no cost at age 65 if:
• You receive or are eligible to receive Social Security benefits; or
• You receive or are eligible to receive railroad retirement benefits; or
• Your spouse (living or deceased, including divorced spouses) receives or is eligible to receive Social Security or railroad retirement benefits; or
• You or your spouse worked long enough in a government job through which you paid Medicare taxes; or
• You are the dependent parent of a fully insured deceased child.
If you don’t meet these requirements, you may be able to get Medicare Part A by paying a monthly premium. Usually, you can purchase this coverage only during designated enrollment periods.
Before age 65, you are eligible for Medicare Part A at no cost if:
• You’ve been entitled to Social Security disability benefits for 24 months; or
• You receive a disability pension from the railroad retirement board and meet certain conditions; or
• You receive Social Security disability benefits because you have Lou Gehrig’s disease (amyotrophic lateral sclerosis); or
• You worked long enough in a government job through which you paid Medicare taxes, and you’ve been entitled to Social Security disability benefits for 24 months; or
•You’re the child or widow(er) age 50 or older, including a divorced widow(er), of someone who’s worked long enough in a government job through which Medicare taxes were paid, and you meet the requirements of the Social Security disability program; or
• You have permanent kidney failure and you receive maintenance dialysis or a kidney transplant and —You’re eligible for or receive monthly benefits under Social Security or the railroad retirement system; or
—You’ve worked long enough in a Medicare-covered government job; or
—You’re the child or spouse (including a divorced spouse) of a worker (living or deceased) who has worked long enough under Social Security or in a Medicare-covered government job.
• You’ve been entitled to Social Security disability benefits for 24 months; or
• You receive a disability pension from the railroad retirement board and meet certain conditions; or
• You receive Social Security disability benefits because you have Lou Gehrig’s disease (amyotrophic lateral sclerosis); or
• You worked long enough in a government job through which you paid Medicare taxes, and you’ve been entitled to Social Security disability benefits for 24 months; or
•You’re the child or widow(er) age 50 or older, including a divorced widow(er), of someone who’s worked long enough in a government job through which Medicare taxes were paid, and you meet the requirements of the Social Security disability program; or
• You have permanent kidney failure and you receive maintenance dialysis or a kidney transplant and —You’re eligible for or receive monthly benefits under Social Security or the railroad retirement system; or
—You’ve worked long enough in a Medicare-covered government job; or
—You’re the child or spouse (including a divorced spouse) of a worker (living or deceased) who has worked long enough under Social Security or in a Medicare-covered government job.
When should I sign up?
Even though Social Security’s full retirement age is no longer 65, you should sign up for Medicare three months before your 65th birthday. You can apply on our website at www.socialsecurity.gov.
While you’ll likely be automatically enrolled in Part A once you turn 65, you must actively enroll in Part B or D.
Medicare has 4 parts.
• Medicare Part A (hospital insurance) helps pay for inpatient care in a hospital or skilled nursing facility (following a hospital stay). Part A also pays for some home health care, and hospice care.
• Medicare Part B (medical insurance) helps pay for services from doctors and other health care providers, outpatient care, home health care, durable medical equipment, and some preventive services.
• Medicare Part C (Medicare Advantage plans) are available in many areas. People with Medicare Parts A and B can choose to receive all their health care services through a private insurance company approved by Medicare to provide this coverage. [please read below, Be Cautious]
• Medicare Part D (Medicare prescription drug coverage) helps cover the cost of prescription drugs. You can get more details about what Medicare covers from Medicare & You (Publication No. CMS-10050). To get a copy, call the toll-free number (1-800-633-4227) or go to www.medicare.gov
• Medicare Part A (hospital insurance) helps pay for inpatient care in a hospital or skilled nursing facility (following a hospital stay). Part A also pays for some home health care, and hospice care.
• Medicare Part B (medical insurance) helps pay for services from doctors and other health care providers, outpatient care, home health care, durable medical equipment, and some preventive services.
• Medicare Part C (Medicare Advantage plans) are available in many areas. People with Medicare Parts A and B can choose to receive all their health care services through a private insurance company approved by Medicare to provide this coverage. [please read below, Be Cautious]
• Medicare Part D (Medicare prescription drug coverage) helps cover the cost of prescription drugs. You can get more details about what Medicare covers from Medicare & You (Publication No. CMS-10050). To get a copy, call the toll-free number (1-800-633-4227) or go to www.medicare.gov
Be Cautious
Medicare advantage plans as mentioned above are through private insurance companies. The fact that it is referred to part C can be very confusing. Since Medicare advantage plans are through private insurance companies may not cover any skilled nursing home care, the co-pays may be high and coverage may be different. Before being sold an advantage plan by a slick sales person, be sure that it is really what you want. See 13 Facts about Medicare Advantage plans here
Medicare advantage plans as mentioned above are through private insurance companies. The fact that it is referred to part C can be very confusing. Since Medicare advantage plans are through private insurance companies may not cover any skilled nursing home care, the co-pays may be high and coverage may be different. Before being sold an advantage plan by a slick sales person, be sure that it is really what you want. See 13 Facts about Medicare Advantage plans here
Medicare V Medicaid
Medicare and Medicaid a very different. Medicare as described above is automatic qualification. Medicaid is need based and qualifications are heavily restricted by your medical needs and finances.
Medicare for nursing homes - Medicare will only offer full coverage of your nursing home stay for 20 days and only after a qualifying in-patient hospital stay of 3 consecutive 24 hour periods or more. Days 21-100 you will owe a co-pay of $161.00 per day [which may be absorbed if you have the proper "Medi-gap" insurance]. after the 100 days all costs will be your responsibility.
Medicaid - Medicaid, for the aged [65 or older] blind or disabled is designed to cover 100% of your nursing home costs once you qualify. Qualification is a grueling process and you should have an expert assist you to ensure a fast approval which will eliminate your nursing home costs. You only apply for Medicaid when you need it such as needing care in a nursing home, assisted living facility or in some states even at-home care. Financial qualifications are rigorous but an exert will help you qualify even if your assets are higher than the state limits. For more Medicaid FAQ's read here.
If you have any questions regarding Medicare or Medicaid, contact us today! 855.471.6771
Author Paul Lorah is a Medicaid and Long Term Care Planning expert who has authored such books as "Planning and Paying for Long Term Care' and "How to Get Medicaid to Pay for Your Long Term Care Costs".
