Medicare Eligibility
Medicare is a government subsidized insurance that is for people that are 65 years of age or older. American citizens under the age of 65 with disabilities and illness may also be eligible. Individuals of all ages with End-Stage Renal Disease or Lou Gehrig’s Disease will be eligible for the program. Candidates for Medicare should apply within three months of their 65th birthday or within the annual enrollment period.
If you are receiving Social Security checks, your enrollment into the program will be automatic. The Medicare card will come three months before your 65th birthday. The benefits will be on the first day of the first month of the 65th birthday. If you are not automatically enrolled, contact the Social Security Administration office at (800) 772-1213 to receive benefits.
What Should I Expect to Receive When I Become Eligible?
There are four different parts of Medicare. However, the two most common parts include Hospital Insurance (Part A) or Medical Insurance (Part B). Medicare Prescription Drug Plan will also add a drug plan in Part D coverage. Part C combines Part A and Part B in a Medical Advantage Plan. Each portion of the Medicare Benefits will be explained below:
Medicare Part A: Hospital Insurance
Part A of Medicare covers inpatient care and critical access hospitals. Skilled nursing facilities, hospice care and other home health is covered with this particular part of Medicare. Custodial or long-term care is not covered by Part A of Medicare. Part A of Medicare is covered for free if you have worked and paid for through Medicare taxes while working. You can find out your eligibility by contacting the Social Security office.
Medicare Part B: Medical Insurance
Medicare Part A does not cover doctor’s services and outpatient hospital care. Part B will pay for covered services and supplies when they are medically necessary. The costs for Part B will vary depending on the private insurance carrier chosen to cover this portion. If you have an income of $85,000 or less, you will not have an increase in Part B premium for 2011.
In 2011, the standard premium for Medicare Part B is $115.40. This cost is a 4.5% increase over the 2010 costs for Part B. If you do not select Part B when you first become 65, then the premiums may be higher. The cost may be increase by 10% each calendar year after you are 65 and do not sign up, except in special cases.
Medicare Advantage Plans are private Medicare approved health plans for those individuals eligible for Medicare. You are still in Medicare. However, you may receive private coverage with Medicare costs. Each plan will charge different out of pocket costs and have different networks for doctors that you must see to get care.
Medicare Part D is a prescription drug coverage insurance program. Most people coverage by this insurance may have to pay a premium for this coverage. All medically necessary drugs will be covered under this program. The different drug plans will be best suited to your needs. Once the patient reaches a certain amount, the prescription drug insurance will experience a gap until an out-of-pocket amount is met. Then, the insurance will resume coverage after this amount is reached.
Welcome to Medicare Physical Exam
Those that are new to Medicare will need to schedule a Medicare physical exam as a preventative measure. This will also help you determine any other preventative tests that you may need to receive. Each eligible patient will need to take advantage of this exam.
Conclusion
Patients on Medicare may still be required to pay co-insurance, deductibles or co-pays. A medi-gap policy may be necessary to cover these costs. Overall, Medicare can provide coverage necessary to ensure the health needs of the patient are met. Each patient at the age of 65 should make every effort to enroll before the prices of Medicare increases.
