Although Medicare was created to make healthcare easier for those in need, the system itself may not be easy to navigate. If you are encountering the Medicare program for the first time, you might have all kinds of questions about eligibility, benefits, retirement, and much more. Fortunately, a little internet research goes a long way. By answering five of the most common Medicare questions, we can provide you with plenty of insights. Using these insights, you can make a more informed decision about your Medicare journey.
- Who is Eligible for Medicare?
One of the most obvious questions about Medicare involves eligibility. Determining whether you are eligible for Medicare should be your first step in this process, as there is no point in pursuing this further if you will simply be rejected. So how do you know whether you are eligible for Medicare?
According to the US Department of Health and Human Services, Medicare is primarily geared toward people who are 65 or older. In other words, this problem was designed specifically for retirees. That said, there are a few groups who may become eligible for Medicare even before the age of 65. These groups include:
- Those with disabilities
- Those with End-Stage Renal Disease
- Those with ALS
In addition, there are a few other requirements to consider if you are planning to apply for Medicare. First of all, you need to be a US citizen to qualify for this program. Alternatively, you can qualify if you are a permanent legal resident, but only if you have lived in the country for at least five years.
Finally, you may need some kind of work history in the United States in order to qualify for this program. Those who have been receiving Social Security often qualify for Medicare, and Railroad Retirement recipients fall into the same general category. Alternatively, you may qualify for Medicare if you are a government employee or retired government worker. These government workers may qualify even if they have not paid into Social Security – as long as they have paid Medicare payroll taxes during their career. In addition, you may qualify for Medicare if your spouse is a government worker who falls into this category.
- What Kind of Benefits Does Medicare Provide?
The coverage and benefits provided by Medicare may vary depending on your choices and your unique circumstances. Most Medicare recipients are faced with one major choice, and this is a choice between “Original Medicare” and a “Medicare Advantage Plan.” Medicare Advantage is also known commonly as “Part C.”
Original Medicare consists of Part A and Part B. This plan is completely managed by the federal government, and it covers a wide range of healthcare providers. The government pays a portion of the total cost of these medical services.
Part A focuses on hospital care, and it may include nursing homes. On the other hand, Part B covers regular visits to the doctor for non-emergency reasons. In addition, Part B may cover various supplies and additional services, as long as they are “medically necessary.” Finally, Part B includes certain types of preventative care, ambulance services, some mental health treatment, and certain prescription drugs.
While Part A and B are covered by the federal government, Part C is entirely handled by private insurance companies. Also known as Medicare Advantage, this program provides all of the benefits listed under Parts A and B while also offering additional coverage for prescription drugs. A number of additional healthcare services may be bundled together with Advantage plans, including vision, hearing, and dental care.
- When Should I Claim Medicare?
Generally speaking, it is a good idea to claim Medicare as soon as you become eligible. There are certain penalties for signing up late, and you need to be aware of the specific enrollment periods that apply to your situation. The most obvious option is to sign up for Medicare as soon as you turn 65. Whatever the case may be, you can feel relatively confident about being accepted as long as you are 65 years of age. Another option is to leave your active group health plan and transition to Medicare.
In fact, you can start the enrollment process three months before you turn 65. This is known as the Initial Enrollment Process or “IEP.” In addition, you can apply three months after you turn 65 – which gives you a total of 6 months to file your application during this window. As previously noted, there are certain situations in which people may become eligible for Medicare even before they turn 65 – so it’s probably a good idea to begin the conversation with an elder law attorney as soon as possible.
- What is the Difference Between Medicare and Medicaid?
People often get Medicare and Medicaid confused. While Medicare is essentially just a state-funded health insurance plan, Medicaid is basically a type of welfare. Medicaid has more strict eligibility requirements, as this program is specifically geared toward people with limited resources. In addition, Medicaid may provide coverage for things that Medicare may not cover, such as nursing home care. Medicaid may also cover younger adults or even children, while Medicare targets elderly individuals.
- What is Part D of Medicare?
Part D of Medicare refers specifically to prescription drugs. This is an option upgrade for your standard Medicare plan, and it is included in Advantage plans. That being said, some types of prescription drugs are covered by Plan A and D.
Who Can Help With My Medicare Journey?
While internet research is a positive first step, it can only get you so far. Aside from these five common questions, there are many other confusing aspects of Medicare that can be difficult to wrap your mind around. In order to approach this process with a degree of confidence and efficiency, it may be worth booking a consultation with the Elderly Care Law Firm. During this initial meeting, you can ask any additional questions about the Medicare process. Reach out today to get started.
