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When it comes to healthcare, it is vital to know what is covered and what isn’t in your plan. Due to many different plans for Medicare, it can be challenging to know which plan will give you the right coverage. Luckily, we can make it easier for you to purchase the right plan.

Medicare Part A

Medicare Part A is part of Original Medicare and generally covers inpatient care like hospital or inpatient-like settings, including care received from a skilled nursing facility, hospice, and some home-based health care. Most people are automatically eligible for this plan at age 65 and above if they are already collecting retirement benefits from Railroad Retirement Board or Social Security Administration.

You can still qualify for Medicare Part A before you reach the age of 65, but the applicant must have a disability, End-Stage Renal Disease (ESRD), or Amyotrophic Lateral Sclerosis (ALS). The applicant must also be a U.S. citizen or a permanent resident of at least five continuous years. Overall, Medicare Part A coverage includes skilled nursing facility care, hospital care, and limited home health services.

Note that some of the benefits above are only covered in limited situations, and certain conditions must be met.

Medicare Part B

Medicare Part B is also part of Original Medicare, which covers medical supplies and services that are medically required to treat you. Medicare Part B can include outpatient care, ambulance services, preventative services, and quality medical equipment. This Medicare plan also covers intermittent or part-time rehabilitative and home health services like physical therapy if required to treat your health condition.

Some of the preventive services covered by Medicare Part B include preventive visits, diabetes screenings, cancer screenings, hepatitis B shots, cardiovascular screenings, and more. Any individual who is eligible for premium-free Medicare Part A is also eligible for this type of Medicare plan

Medicare Part C

Medicare Part C (also known as Medicare Advantage) is a comprehensive Medicare plan that incorporates medical, hospital, and prescription drug coverage. Medicare Part C also covers extra services not offered by traditional Medicare plans such as vision, dental, and hearing care. However, Medicare Part C coverage varies between plans. You can only buy a Medicare Part C plan through private insurers rather than purchasing through the government itself.

People who already have Medicare Parts A and B also qualify for Medicare Part C. Those that stay in the service area of the Medicare Part C plan provider of interest can also enroll for the plan. That said, it is vital to note that even if you meet all these requirements, patients with renal diseases don’t usually qualify for Medicare Part C.

Medicare Part D

This is a Medicare plan that offers drug coverage for outpatients. Unlike Original Medicare offered by the United States federal government, Medicare Part D is only offered through private insurance firms with active contracts with the government. If you want to get this coverage, you need to select and enroll in a Medicare Advantage Plan with Drug (MAPD) coverage or a private Medicare Prescription Drug Plan (PDP).

Though enrollment is recommended to avoid incurring future penalties, it is optional and only required during approved enrollment periods. Signing up for Medicare Part D plans usually depends on the situation. For example, if you have creditable drug coverage from your retiree insurance or employer, you don’t have to enroll in Medicare Part D until you lose this coverage.

What Is Medicare?

Medicare is a health insurance program created by the United States Government to subsidize healthcare services to people that have reached the age of 65 who didn’t have health insurance coverage. Medicare is overseen by the Centers for Medicare and Services (CMS), an agency within the U.S. Department of Health and Human Services. This program also extends coverage for individuals with particular disabilities, and those who have Amyotrophic Lateral Sclerosis (ALS) or End-Stage Renal Disease.

Medicare Eligibility

Medicare eligibility depends on specific criteria. Anyone who has lived in the United States for at least five years and is about the age of 65 qualifies for Medicare coverage. People under the age of 65 may qualify for Medicare if they receive Social Security Disability Insurance. However, those who receive Social Security disability benefits need to wait for two years after receiving their first check before being eligible for this program.

Anyone with kidney failure or ALS automatically qualifies for Medicare, no matter the age of the applicant. If you are insured, or your spouse has contributed to Medicare for ten years or more through payroll taxes, they can get premium-free Medicare Part A. However, the other parts of the Medicare program require you to pay for premiums.

Medicare is funded through several different sources. For example, United States taxpayers contribute to the Medicare program through the Federal Insurance Contributions Act (FICA). This goes towards Medicare deductions and Social Security. As of 2020, workers contribute a total of 7.65 percent of their paychecks to the Federal Insurance Contributions Act: 1.45 percent to Medicare, and 6.2 percent to Social Security. In addition, employers pay the same percentage of money on behalf of the employee.

While Medicare offers consumers more choice in terms of coverage and costs, it also introduces complexity for the people looking to sign up. The decisions surrounding this program can become overwhelming without the right help.

Enrolling In Medicare

Medicare can be challenging. Many worry that they don’t have enough information as they prepare to enter Medicare and feel tense about this process. For some people, enrolling for Medicare is automatic, while for others, it depends on certain factors, and we are here to help. The steps you take before enrolling in Medicare will depend on whether you are still getting your retirement benefits when you start the Initial Enrollment Period.

Anyone that is receiving SSRB or RRB can automatically enroll in both Medicare Part A and Part B, but for the people that are not receiving these benefits, they’ll need to actively enroll in Medicare. If you are eligible for automatic Medicare enrollment, you will get a parcel in the mail three months before your health coverage starts with your new Medicare card.

Moreover, you’ll get a letter that explains how Medicare works. You can automatically enroll in both Medicare Part A and B. As for the people that get Social Security Retirement benefits, their card and package will come from SSA. In contrast, those that get Railroad Retirement benefits will get their card and package from the Railroad Retirement Board.

You shouldn’t turn down Medicare Part B unless you or your partner still have job insurance that gives them coverage. If you turn down Medicare Part B without having insurance from your current employer, you may suffer a premium penalty if you want to enroll in a Medicare plan in the future.

Moreover, if you become eligible for Medicare while still receiving coverage from your job-based insurance, you can enroll in Medicare to pay less for your care and have primary coverage. If you are 65 years old and not receiving Railroad Retirement benefits or Social Security benefits, you’ll need to actively enroll in a Medicare plan.

Signing Up For Medicare

If you need to enroll in Medicare, the steps below can be your guide. If you are considering Medicare enrollment during your IEP, you can sign up for Medicare Part A or B as follows:

• Go to your local social security office
• Mail a dated and signed letter to a Social Security that includes your name, SSN, and the date you want to enroll in Medicare, you can apply online.
• If you are eligible for RRB, enroll in Medicare by contacting your local Railroad Retirement Board or calling RRB.
• To protect yourself from incurring a Medicare Part B premium penalty in case your application is lost, ensure to keep proof when you tried enrolling in Medicare.
• Ensure to take note of the Medicare agent you talk to, along with the date and time of discussion