Most people all over the world at some point take cover against the unpredicted. This cover may be insurance that safeguards a person’s property from events like theft and burglary, fire, third-party liability, and so on. This is no different in the field of medicine.
Citizens of a given country may opt for various health insurance policies to safeguard them in their old age. Among the crucial medical cover one may enroll in is none other than medicare. But what is Medicare? Who is eligible for this cover? At what age? What are the qualifications for this cover? Are there parts of Medicare? To ensure you are not left out on this mysterious journey to unfold what this cover is about, get on board and fasten your seatbelt because this might be a game changer.
What is Medicare?
This is a government (national) health insurance cover in the United States of America. It was started way back in 1965 under the Social Security Administration, but today it is administered by the Centers for Medicaid and Medicare services.
Medicare Eligibility
This health insurance program is not only for the aged (65+ years persons) but also available to the younger persons with health complications such as permanent kidney failure. However, to be Medicare eligible, there are certain conditions you must meet. Such conditions include:
- You are aged 65+ years.
- You must be a permanent resident of the U.S. (lawful residence).
- You must be receiving Social Security Retirement (SSR) benefits.
- You are receiving U.S. Railroad Retirement Boards (RRB) benefits.
- You must be on Social Security Disability Insurance (SSDI).
In case you are eligible for this program and fail to enroll, you are likely to pay extra enrollment fees. It is important to note that there are other special enrollment periods you sign up for.
This program has separate parts as shown here. Have a look.
- Medicare Part A
This is better known as Medicare Hospital Cover. The patients under this cover are those in need of special care. Some of the services covered in this part include inpatient hospital care and home health care which covers you for 100 days and you must have been inpatient for at least three consecutive days. Other services include hospice care (specifically for terminally ill patients), lab tests, skilled nursing facilities, and surgery.
- Medicare Part B
Mainly concerned with services not offered in part A. the beauty of this part is that it is optional. Services offered here are such as therapy services, durable medical equipment, ambulance services, clinical research, blood clotting and antigen, X-ray therapy, Dialysis drugs, Hepatitis B, Pneumococcal, and Influenza vaccines.
- Medical Advantage (Part C)
It is provided by private insurance and offers coverage to both hospital (part A) and outpatient (part B) Medicare respectively. For you to enroll for Part C, you must be residing within the area of Medicare Advantage.
Its services include dental, hearing, home-meal delivery, gym membership, and transportation (patients from healthcare to healthcare).
It is important to note that this part has two kinds; Health maintenance organization and the preferred provider organization.
- Part D
It is also referred to as Medicare Prescription Drug Benefits. It covers several drugs. The commonly prescribed drugs include HIV/AIDS treatments, antipsychotic medication, anticonvulsive treatment, anticancer drugs, antidepressants, and immunosuppressant drugs.
Qualifications
Some of the known qualifications that make you eligible for this program are:
- You are having permanent kidney failure and dialysis.
- You have paid Medicare taxes. These taxes will later act as premiums.
- Must be 65+ years.
Perhaps you are thinking that only persons aged 65+ years are the only ones who qualify for this cover. This thought is invalid. Well, to shade a little light, even persons under the specified age of 65 years are also eligible. Some of the instances that can make you qualify for this program at a younger age (less than 65 years) include:
- a) You are receiving monthly benefits under Railroad Retirement Boards and Social Security benefits.
- b) You have a kidney transplant or end-stage renal disease.
- c) You have worked and paid Medicare taxes under the government.
- d) You are divorced, a child, deceased, or spouse of a government worker who has worked for acceptable years in a Medicare covered government job.
- e) You have been entitled to RRB benefits for 24 months.
- f) You are below the age of 50 years and meet all the requirements of SS benefit.
Can you get Medicare benefits if you don’t qualify for free? Yes, you can. But for such a circumstance, you’ll have to buy Medicare Part A. the premium you’ll pay is dependent on how long you’ve worked and paid the program’s taxes. One thing to understand is that if by any chance you don’t consider part A, you can opt for part B.
Besides eligibility, age, and qualification, you should also consider enrollment. A person is likely to enroll for Medicare three months before they turn the age of 65 years, or celebrate their 65th birthday. Medicare has various enrollment opportunities such as the Open Enrollment Period (OEP), Initial Enrollment Period (IEP), and Special Enrollment Period (SEP).