When it comes to health insurance in the US, things can get a bit confusing. While the US does not provide health insurance to most US citizens, it does provide programs for individuals with disabilities and retirees called Medicare.
What Is Medicare
Medicare is a government-run health care program for people over age 65, people with disabilities, or people with end-stage kidney disease (needing dialysis or kidney transplant), who have retired or can no longer work for various health reasons, and they can’t afford to pay for a regular health insurance plan on their own.
The program covers most, but not all, medical costs or long-term care expenses.
You have the option of choosing just Original Medicare or adding supplemental coverage. If you qualify for Original Medicare plan (Part A and Part B), you can enroll in a Medicare Supplement plan (Medigap) and add separate drug coverage Part D from a private health insurance company. You also have the option of enrolling in Part C which are commonly known as Medicare Advantage plans. Important to note when you enroll in Original Medicare you are considered a beneficiary. Medicare beneficiaries are allowed to enroll in Medigap or Medicare Advantage plans but they cannot have both.
The Parts of Original Medicare
Original Medicare (Part A and Part B)
- Medicare Part A (hospital insurance) contributes towards the cost of hospitalization or a short-term stay in a specialized care facility (following a hospitalization). Part A also pays for part of the cost of nursing home and nursing home care services.
- Medicare Part B (medical insurance) covers outpatient services such as doctor and other health care providers, ambulatory care, home health care, durable medical equipment, and some preventive services.
- Other parts of Medicare are insured by private health insurance companies. Supplemental policies (Medigap) can be provided at an extra cost and offers partial insurance and deductibles.
- Medicare Advantage Plan (also known as Medicare Plan C) includes all the benefits and services of Parts A and B – prescription drugs, as well as benefits for eye, ear, and dental visits, all combined into one plan.
- Medicare Part D (prescription drug coverage) covers only prescription drug costs.
Who Is Eligible For Medicare?
According to the Department of Health and Human Services, you can get Part A of Medicare if you are over 65 years old and if you or your spouse have worked and paid Medicare taxes for at least ten years. You get Part A at no extra charge under the following circumstances:
- You are collecting retirement benefits from the Social Security or Railroad Retirement Board
- You are eligible to get retirement benefits from the Social Security or Railroad board but have not yet enrolled for them
- You or your spouse worked in a Medicare-insured environment.
But what happens if neither of you have paid for Medicare and you are now over 65 years old? You can still buy the Part A plan, but you will have to pay for it.
How to Apply to Medicare
If you are less than three months away from reaching age 65 or older and are not yet ready to start receiving monthly Social Security benefits, you can use an online application to sign up for Medicare and wait to request retirement benefits or spousal benefits later. It takes less than 10 minutes, you don’t have to fill out any forms, and usually, no documentation is necessary.
Design Health is here to help you understand and choose the Medicare plan that’s right for you and your family.
If you have any questions, we’ll be happy to explain them to you.
Call us at (720) 330-2283 or contact us here, and we’ll help you choose the best option for you.