Medicare

Pills falling out of rolled up money

The idea for a national health insurance plan such as Medicare first took shape with President Harry S. Truman in the 1940s. Two decades later, Lyndon Johnson signed official legislation creating Medicare, health insurance for seniors, into law with Truman as the first member. Since then, changes to the program have included prescription drug coverage and certain health treatments regardless of age.

What Is Medicare?

Medicare is health insurance for those over 65 or those under the age of 65 who have certain disabilities. It is the largest health insurance program in the United States, providing coverage to 40 million Americans. There are two parts to original Medicare--Medicare Part A (also known as Hospital Insurance) and Medicare Part B (Medical Insurance).

Medicare Part A

Part A provides coverage for hospital, hospice, skilled nursing facility, or home health care (under certain conditions). If you, or your spouse, paid into the Medicare system throughout your working years, you do not have to pay monthly premiums for Part A. It is also possible to pay a premium for this coverage if you do not qualify otherwise.

Medicare Part B

Part B provides coverage for any medically necessary doctor care or services. It also provides coverage for outpatient and some preventative care. This portion of Medicare requires a monthly premium payment.

Medicare Part C

In addition to original Medicare, there are supplemental plans to consider. Medicare Part C, also known as Medicare Advantage Plans, is an additional, supplemental, and optional plan. It provides all of Part A and Part B along with additional services. Most people pay a monthly premium for this coverage, but they benefit from having lower coinsurance and deductible costs. You can also obtain these plans along with Part D coverage, however, Part C plans are offered from a private insurance company that Medicare approves. The types of benefits you can obtain from Part C and the costs vary between insurance companies.

Medicare Part D

Part D is a prescription drug coverage plan, run by private insurance companies. The costs and types of coverage differ between the insurance providers.

Eligibility

In order to obtain Medicare, you must meet specific qualifications aside from those previously listed. The organization makes it easy to determine if you qualify by filling out information at the Medicare.gov Eligibility Tool.

To be eligible, individuals must live in the United States for five years and have entered the country lawfully. If you are over the age of 65, you likely qualify. If you are under this age, you must show proof of a qualifying medical condition. Those who have kidney failure, Lou Gehrig's disease, and other disabilities who qualify for Social Security Disability benefits are eligible for Medicare after two years.

Applying for Medicare

If you are currently getting Social Security checks, enrollment into Medicare is usually automatic with benefits beginning the first day of the month of your 65th birthday. To enroll otherwise, contact the Social Security Administration by calling 800-772-1213, visiting the official website SSA.gov, or applying at your local Social Security Office. Individuals can apply up to three months prior to their 65th birthday to ensure that benefits begin on time.

It is important to meet enrollment periods when applying for Medicare. The organization limits the ability of users to drop or add coverage after your official enrollment periods expires.

Initial Enrollment Period

The best time to sign up is between seven and three months prior to your 65th birthday, ending three months after your birthday month. During this period, you are able to sign up for any coverage you want or need.

If you fail to sign up during these enrollment periods for Part B coverage, for example, you may pay a higher monthly fee when you sign up later, although there are exceptions to this rule. For example, those who currently have quality drug coverage in place outside the Medicare system will not be charged a higher fee for signing up later. Those who are still working after turning 65 and have continuous health insurance through that time can also wait to sign up for additional coverage without paying a fee.

Other Enrollment Periods

After you enroll into Medicare, the organization allows you to make changes to your coverage only during enrollment periods. In most cases, to enroll in Medicare Part B, you must do so during the months of January through the end of March. If you enroll during this time, your Medicare Part B coverage begins in July of the same year. For those who wish to enroll in the Medicare Prescription Drug Coverage program, you can usually do so between November 15th through December 31st each year with plans beginning the following year. To find out official enrollment periods for the current year, visit MyMedicare.gov.

Using Medicare and Getting More Help

Medicare makes it easy for you to use its insurance plans, however, you need to consider what you need and where to find providers.

  • If you have Medicare Part A, managed through the federal program alone, you can visit the Find a Doctor website to locate doctors approved to provide care.
  • If you have other types of coverage through third party providers for Part C or Part D, for example, you need to contact those insurance companies to find providers.
Medicare