Medicare is a national health insurance program for seniors, certain people with disabilities, and sometimes their families. It offers healthcare coverage when they would otherwise have difficulty affording it. In the United States, Medicare is administered by the Centers for Medicare & Medicaid Services (CMS). The program has three parts: Medicare Part A is hospital insurance and pays for inpatient hospital services; Medicare Part B pays for physicians’ services and outpatient hospital care, and Medicare Part D pays for prescription drugs. Medicare also provides medical insurance to people eligible for Social Security benefits, some disabled workers, and veterans (for those who were serving on active duty at the time of the program’s launch in 1965).
Medicare was enacted in 1965 by the Social Security Amendments of 1965 according to clearmatchmedicare.com. It was signed into law by President Lyndon Johnson. The legislation provided insurance to senior citizens on a prepaid basis, with the government paying part of their hospital expenses. Medicare was intended to solve two problems. The first was that senior citizens were not accustomed to paying for most of their own healthcare needs and would wait until they needed it before seeking the care. The second problem was that, even if they had the money to pay for care, many were often unable or unwilling to pay the total treatment costs.
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How to qualify for Medicare
To qualify for Medicare, you must meet certain requirements. These include being a US citizen or legal resident, having been in the US for five years before your 65th birthday (five out of the last six years), and having paid into Medicare throughout your working career. Additionally, you must be at least 65 and not entitled to payments from the Railroad Retirement Board or a disability program through Social Security.
Under normal circumstances, qualifying is easy because Medicare follows the requirements set by the Social Security Administration under Title II of the SSA. In some cases, however, it might be impossible for seniors to receive full benefits immediately upon reaching age 65 due to certain restrictions that may apply. For example, to qualify for Medicare, individuals must reside within the US, which means they cannot be overseas at the time of their 65th birthday. In some cases, they may have to file a form to be eligible for coverage under the immediate eligibility provisions.
Medicare recipients can also become eligible for additional benefits by meeting specific requirements. They may qualify for Part A and Part B of the Medicare program by working a minimum number of hours in covered employment. Alternatively, they may qualify by paying into Social Security according to a specific formula designed to ensure that those with lower incomes will receive larger total benefit amounts than those with higher incomes. The recipient can also buy into the Medicare program by paying for a portion of their healthcare costs from their resources, such as:
- Part A premiums are withheld from the Social Security checks of recipients who are working and have enough earnings to be required to pay into Social Security. Part A is generally free for those who paid into Social Security for at least forty quarters, but it can also be purchased through their state’s Medicare agency for a monthly premium. In most cases, individuals who were not required to pay Social Security taxes because their income was too low will have the premiums withheld from their cash benefits from the Supplemental Security Income program instead.
- Part B premiums are paid directly by Medicare recipients either through automatic withholdings from their monthly Social Security checks or directly out of their resources. The premiums are generally deducted as a percentage of the Social Security benefits, but they are not withheld directly from Social Security checks. This premium will be used to pay for the medical services provided under Part B of Medicare. The monthly premiums for Part B are quite small, although there is an enrollment fee for those who purchase it independently.
- Part D premiums are also accessed through Social Security by having the premium withheld from your monthly benefits or your bank account when you elect direct deposit for the benefit check. The amount you pay out of pocket for these premiums depends on your income and can vary depending on your financial situation. While most seniors are entitled to receive some aid to help offset their costs, some seniors may be responsible for paying the total amount out of pocket, while others will pay no premiums at all. Medicare Part D plans must include coverage for prescription drugs and medical supplies and generally cover more services than Original Medicare does alone.
Factors to Consider When Choosing Plans
When choosing a Medicare plan, there are several factors that you need to consider to make an informed decision about which plan or plans will work best for them based on their unique needs and financial situations. These include:
The first of these factors is cost, which arguably has perhaps the most significant impact on overall benefits. Generally speaking, Original Medicare plans are more expensive than Medicare advantage plans because they provide the full benefits of Medicare without limit of the out of pocket costs that an individual might have to pay.
- Quality of care
The quality of care provided under these plans can vary widely, which is another factor you should consider. In some cases, you may find that the coverage provided by a plan is very comprehensive, but the quality of care available under the plan is lower than average. Other times, you may find that a plan has a high level of network providers but doesn’t cover as many services as you’d like.
- Prescription drugs
Medicare plans often vary significantly in terms of the prescription drugs that they choose to cover. In some cases, they may provide comprehensive coverage, while they might offer limited prescription drug coverage in others. It’s important to note that Medicare never provides coverage for all of the drugs you may need, but it does provide access to many established name brands at a price that’s generally much lower than what you’ll pay for them without insurance.
Another essential factor is coverage, which can be complicated because Medicare plans vary in how they cover services. Original Medicare covers what is covered under part A and part B of Medicare. The additional coverage under part D is not covered by original Medicare. Medicare Advantage plans generally cover the same level of benefits as Original Medicare but has additional services provided to the patients beyond that level. These services include dental coverage, vision coverage, and often additional medical services.
To make an informed decision about which plan or plans might be best for them, it is crucial to take as much time as needed to learn about each plan’s benefits and drawbacks. This can be accomplished by listing out your current medical needs and wants and things you might need in the future, such as prescription drugs. Sometimes, Medicare plans will offer extras such as vision benefits or discounts on hearing aids or other medical supplies. This list should be reviewed against the list of benefits offered under each plan to determine which one provides the most significant overall benefit with the least out-of-pocket expenses possible. To learn more about how to qualify for Medicare on Original Medicare, check out https://clearmatchmedicare.com for more information about the program’s requirements, health benefits, and coverage specifics.