What is Medicare And Its Uses?
Medicare is a federal health insurance program for seniors and people under the age of 65 who have certain illnesses or disabilities.
Its coverage helps control aging-related medical costs. Medicare doesn’t cover everything.
What is Medicare?
Medicare Parts A, B, C, and D. Each part’s cost and coverage vary.
- Part A includes hospital care.
- Part B includes outpatient and doctor visits.
- Private insurers offer Part C, which offers the same benefits as A and B.
- Part D covers medicines.
Here are some Medicare costs and coverage details.
Medicare Eligibility
Medicare is available if you’re 65 or older and a U.S. citizen or five-year legal resident. Medicare provides assistance to disabled people under the age of 65.
After two years, Social Security disability recipients can get Medicare.
End-stage renal disease (permanent kidney failure) patients are automatically enrolled upon signing up, and ALS patients are eligible the month incapacity begins.
Read: How Insurance Works, Its Definition, and Main Types of Insurance
Medicare Overview
Inpatient hospital or skilled nursing facility care. | Premium: $0 for most people; but up to $499 per month in 2022 ($506 in 2023) for those who don’t qualify for premium-free Part A. Deductible: $1,556 in 2022 ($1,600 in 2023). | |
Doctor visits and preventive services. | Premium: Starts at $170.10 per month in 2022 ($164.90 in 2023). Deductible: $233 in 2022 ($226 in 2023). | |
Parts A and B coverage plus vision, hearing, and dental benefits. | Pay Part B and private insurer premiums. (Some plans cost nothing.) Out-of-pocket limit: As much as $7,550 in 2022 ($8,300 in 2023). | |
Generic and brand-name prescription drugs. | Premium: Varies by private insurer; average is $33 per month in 2022 (projected $31.50 in 2023). |
Original Medicare
Original Medicare is managed by the federal government and includes Parts A and B. Medicare pays a large amount of the cost for any doctor who accepts assignment.
We Have to understand the main types of Medicare to fully describe the topic What is Medicare?
Medicare Part A (Hospital Insurance)
Medicare Part A covers hospital or SNF inpatient treatment, but not custodial or long-term care. Part A covers hospice and home health care.
Medicare Part A patients pay a $1,556 deductible in 2022 ($1,600 in 2023) plus coinsurance.
Patients will pay $389 per day in 2022 ($400 in 2023) for the 61st through 90th days of hospitalization and more after that.
If you or your spouse paid Medicare taxes for 10 years, you don’t pay Part A premiums.
Medicare Part B (Medical Insurance)
Part B Medicare covers doctor appointments and supplies. Included are preventive services, ambulance services, long-term medical equipment, coverage for mental health, and prescription drugs for people who don’t live in a hospital.
In 2022, Medicare Part B costs $170.10 per month ($164.90 in 2023). Singles with AGIs over $91,000 ($97,000 in 2023) and married couples with AGIs over $182,000 ($194,000 in 2023) pay more.
Part B Expenses for Medicare and Medicaid Services, 7, 2022
Medicare Part B deductible is $233 in 2022 and 2023. After that, you pay 20% of Medicare-approved services and materials.
Medicare Part B (Penalty)
If you don’t have large employer-sponsored health insurance and don’t sign up for Medicare Part B at age 65, you may have to pay a 10% penalty for each year you wait.
If you had health insurance through your employer or your spouse’s when you became eligible, you can avoid the penalty.
You must enroll within eight months of your coverage ending and show proof of group insurance after 65.
Medicare Part C (Medicare Advantage)
Medicare Advantage, often known as Medicare Part C, is a private health plan that combines Parts A, B, and D.
You must pay your Part B payment and an insurance premium. Many Medicare Advantage plans have $0 premiums.
These packaged plans may include vision, hearing, and dental services.
Unlike Original Medicare, Medicare Advantage programs limit out-of-pocket costs on an annual basis.
Medicare Part D (Prescription Drugs)
Medicare Part D covers generic and brand-name prescriptions. Private insurers offer plans with monthly premiums of $33 in 2022 ($31.50 in 2023).
As with Part B, there is a late enrollment penalty.
The Part D late enrollment penalty is 1% of the national base beneficiary premium, which is $33.37 per month in 2022 ($32.74 in 2023), multiplied by the number of months you’re late.
Medigap (Medicare Supplement Insurance)
Medigap, or Medicare Supplement Insurance, is private coverage that helps pay Medicare Part A and Part B payments.
This includes deductibles, coinsurance, and foreign health care. Long-term care, prescription drugs, dental, vision, hearing aids, and private nursing care aren’t covered.
Most states offer 10 Medigap plans. Medigap requires Medicare Parts A and B. You must choose between Medigap and Medicare Advantage.
Medicare Enrollment
When you turn 65 and start getting Social Security, you are automatically enrolled in Medicare Part A, which covers hospital costs, and Part B, which covers doctor visits.
If you don’t get Social Security, you can sign up for Medicare online.
You should do so in the seven-month window around your 65th birthday to avoid permanent penalties and long insurance waiting periods.
Medigap enrollment begins the month you turn 65 and enroll in Medicare Part B. If you sign up during that period, private insurers must accept you.
Otherwise, they may not sell you a Medigap plan or charge more.
Enrollment Periods
If you get Social Security or are disabled and turn 65, Medicare Parts A and B are signed up for you automatically. Otherwise, enroll yourself. Here’s when:
If you’re not automatically enrolled in Medicare, you’ll have a three-month enrollment period around your 65th birthday.
If your birthday is the first of the month, this includes the four months before and after.
General enrollment period: If you don’t apply for Medicare during your initial enrollment time, you must wait from January to March.
Coverage begins July 1; late fees may apply.
Special enrollment period: You can join Medicare or modify your coverage if you leave a job or move out of your plan’s coverage area.
Medicare Enrollment
Online applications take under 10 minutes.
Reopened Social Security Administration offices require masks and a 6-foot distance.
You must come alone unless you need help, and you may have to wait outside.
If you can’t enroll online, call about in-person appointments. Appointments recommended.
What Medicare doesn’t cover
Common Medicare exclusions include:
Long-term care is the largest uninsured expense.
Medicaid supports custodial costs for low-income, low-savings people.
What Is Medicare Vs. Medicaid
Medicare covers all people over the age of 65, SSDI recipients, and people with certain conditions, regardless of income.
Medicare is a federal program that’s the same nationwide.
Medicaid is a health-care program for low-income people of all ages, with little or no financial responsibility on the part of the patient.
Medicaid is a state-federal program that varies.
Frequently asked questions
Who qualifies for Medicare?
If you’re 65 or older, have a disability and are approved for Social Security disability insurance, or have end-stage renal illness (kidney failure needing dialysis or a transplant), you qualify for Medicare.
Is my doctor Medicare-approved?
If you have Medicare Part B (medical insurance), you can see any Medicare-accepting doctor. Ask your doctor if they accept new Medicare patients.
Some providers don’t accept Medicare in full. Medicare defines providers in three ways:
They accept Medicare and Medicare-approved payments. Nonparticipating providers accept Medicare but may charge more. Opt-out: They don’t accept Medicare; therefore, patients pay all costs.
Having health insurance, do I need Medicare?
It depends on the size of your employer or your spouse’s employer if you have health insurance.
If your employer has fewer than 20 employees, sign up for Medicare Part A and Part B when you’re first eligible.
Medicare will pay your qualified health care costs before your other coverage does.
Ask your benefits manager if you have IRS-defined group health plan coverage if your company has 20 or more employees.
If so, you may be able to put off signing up for Part A and Part B without paying a fee.
If you have marketplace or private insurance and are eligible for premium-free Part A, enroll in Medicare Parts A and B when you’re initially eligible.
If you’re not qualified for premium-free Part A, you can keep your individual coverage.
If you wait to sign up for Part A or Part B when you are first eligible, you may have to pay fines for the rest of your life.
Delaying Part A eligibility results in time-limited fines. Medicare’s website has details.
Medicare eye and dental care?
Original Medicare doesn’t cover cleanings, fillings, tooth extractions, dentures, dental plates, or other dental equipment.
Medicare Part A, which covers hospital stays, will pay for dental care that is needed for another procedure or surgery.
Medicare doesn’t fund eyeglasses or contact lens exams.
Some Medicare Advantage Plans (Part C) offer vision, dental, and hearing services. Visit Medicare’s plan finder to find local plans.
