It seems like every other political news story is about how Republicans want to cut Medicare and how Democrats want to leave it untouched. This makes fine TV news, but for many people under the age of 40 the news story should be “What the heck is Medicare?”
Medicare is one of the oldest social programs in the United States and is used by millions of Americans every day. To find out what exactly Medicare is, how to qualify for it and if you are eligible to use it read on. You may not be 65 now, but stick with us and you will be someday.
What is Medicare?
Medicare is health insurance for people 65 years or older, under age 65 with certain disabilities, and any age with end-stage renal disease (ESRD) or Lou Gehrig's disease. Medicare has four parts: Part A - Hospital Insurance, Part B - Medical insurance, Part C - Medicare Advantage Plans, and Part D - Prescription Drug Coverage. The original Medicare consists of Part A and Part B; and Parts B, C and D are optional.
| Medicare Part A (Hospital Insurance) |
Medicare Part A helps pay for various types of care, including inpatient hospital care, limited nursing home care, and home health and hospice care. Part A generally requires no premiums because costs are covered by Medicare taxes paid during your working years. |
| Medicare Part B (Medical Insurance) |
Medicare Part B helps pay for doctor visits, medical equipment, some preventive services, some outpatient home health and hospital care, rehabilitation therapy, laboratory tests, x-rays, mental health services, ambulance services and blood work. Coverage for Part B is optional. You are required to pay a monthly premium for Part B coverage, deducted from your Social Security payments, plus an annual deductible and a 20% copay. |
| Medicare Part C (Medicare Advantage Plans) |
Medicare Part C offers an alternative to Original Medicare. These plans replace your coverage under Parts A and B, and sometimes include additional coverage. They often (but not always) include a specific network of doctors and health care providers you can use to receive care, sometimes at lower costs. Examples of Medicare Advantage plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs) and Private-Fee-For-Service (PFFS) plans. |
| Medicare Part D (Prescription Drug Coverage) |
Medicare Part D helps reduce the costs of prescription drugs. Unlike Medicare Parts A and B, Part D plans are offered by private insurance companies. Like other insurance, Part D plans require premiums, co-payments, coinsurance and sometimes deductibles. |
How Do I Qualify for Medicare?
You are automatically enrolled in Medicare Part A and Part B effective the month you turn 65. If you are already receiving Social Security benefits, you don't need to do anything - except have your 65th birthday.
If you are close to age 65 and not yet getting Social Security benefits or Medicare, you can apply for both at the same time. To make sure that your Medicare Part B coverage start date is not delayed, you should apply three months before the month you turn 65.
Because you will pay a premium for Medicare Part B, you are allowed to opt out. You will be contacted by mail a few months prior to becoming eligible with instructions for how to do this.
If Medicare does not cover everything that you may need, you can buy Medicare Supplemental Insurance, or Medigap. A Medigap policy is health insurance sold by private insurance companies to fill the "gaps" in Original Medicare Plan coverage.
Medicare has been around for over 50 years and was officially signed into law in July 1965.
With Original Medicare (Parts A and B) you are free to choose any doctor or hospital that accepts Medicare.
Some people who wait to sign up for Medicare Part B until after their initial qualification period has expired must pay late enrollment penalty.
If you are close to age 65 and not yet getting Social Security benefits or Medicare, you can apply for both at the same time. To make sure that your Medicare Part B coverage start date is not delayed, you should apply three months before the month you turn 65.
To get drug coverage under Original Medicare (also known as Part D), you must also choose and join a Medicare-approved drug plan provided by a private insurance company.
Medicare Part D drug plans do not cover every prescription medicine and they do not cover over-the-counter medicines.
The Republicans (led by Paul Ryan and the Ryan Plan) want to slash Medicare, if not end it altogether. If you want to preserve Medicare for you and future generations, vote Democratic.
To find out more about Medicare, visit the official Medicare website Medicare.gov.
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