Medicare Coverage Eligibility and Benefits

When looking into Medicare coverage it's important to look into Medicare eligibility along with the Medicare benefits that can be expected.

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Medicare is a government funded health insurance for people over 65. Certain people under 65 can receive Medicare benefits, including those with certain disabilities and those with End-Stage Renal Disease, a type of permanent kidney failure).

Medicare has different parts that cover different types of services that have different costs.

1. Medicare Part A coverage hospital care. Part A is free for most people who paid Medicare taxes. There may be a cost for those who were self-employed or didn’t work when they were younger.

2. Medicare Part B covers doctors’ services, outpatient care, and some preventive services. Most people will pay $96.40 for Part B coverage. However, those with personal income over $85,000 and household income over $170,000 will pay higher premiums.

3. Medicare Part C is provided by Medicare-approved private companies and includes Part A, Part B, and other benefits like prescription drug coverage. You’ll pay for Part B coverage along with a premium for the plan itself.

4. Medicare Part D lowers the cost of prescription drugs. Part D plans have varying monthly premiums and annual deductibles.

People who choose to enroll in Medicare have the benefit of choosing between a few choices.

  • Original Medicare is run by the federal government and provides Part A and Part B coverage. Part D can be added to help reduce the cost of prescription drugs. There are some gaps in Part A and Part B Medicare coverage that may be filled with Medicare Supplement Insurance, also known as Medigap.
  • Medigap is a private insurance plan that helps may for medical expenses that aren’t covered by Medicare. If you enroll in a Medigap plan, you’ll be subject to an extra insurance premium.
  • Medicare Advantage Plans are run by Medicare-approved private companies. These plans include HMO and PPO choices that provide both Part A and Part B coverage. The amounts charged for services vary by plan and insurance company. Medicare Advantage Plans often include drug coverage and eliminate the need for Medi- gap insurance.
  • Medicare Cost Plans are available only in certain parts of the United States. Unlike Medicare Advantage Plans, you are not required to have Part A. Charges from a non-network service provider are covered under Original Medicare. You can join a Medicare Cost Plan whenever the plan is accepting new members, rather than waiting for the general enrollment period. You also have the ability to leave the plan and return to Original Medicare at any time.
  • From time to time, Demonstrations and Pilot programs are offered to test improvements tomMedicare. Since these plans are for testing purposes only, they’re only offered for a limited period of time, in a specific area, and for a certain group of people.
  • Programs of All-Inclusive Care for the Elderly or PACE provides services for frail elderly and disabled people who are 55 and older and have been certified by the state as needing care at nursing home level. To receive PACE benefits, you must live in a state that offers the program.
  • Medicare eligibility does not include Medicaid eligibility, which is commonly confused with Medicare coverage. Medicaid is not part of Medicare. Instead, it’s a state-level government program designed to help low income families pay for medical care.

You can receive more information about Medicare by calling 1-800-MEDICARE or by visiting www.medicare.gov.

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