Medical health insurance is a
government program that provides health insurance (health coverage) for people
who are you are 65 and above, below 65 and with end-stage renal disease (ESRD),
and below 65 and receive Social Security Disability Insurance (SSDI). The
federal agency saddled with this responsibility is the Centers for Medicare
& Medicaid Services (CMS). This program gets part of its funding from the
Medicare and Social Security taxes that are deducted from the income of
workers. Part of its funding comes from premiums for Medicare, and the federal
budget funds the rest.
Once you're eligible for Medicare and you sign up, you can decide to get your Medicare benefits through a regular payer program offered by the government, Original Medicare, or through Medicare Advantage, a form of private insurance provided by companies that have a contract with Medicare.
How
does Medicare work?
Medical
insurance with Medicare works like private health insurance: it pays a part of
medical costs. In many instances, the beneficiary will be obligated to pay the
deductible. To help pay for services not covered by Medicare, a person can
choose to pay for co-insurance (also called Medigap).
Medicare usually pays all of many preventive services, such as annual mammograms, prostate, annual wellness visits, heart exams (every five years), bone exams, annual flu shots, and cancer screening.
Eligibility
If
you are a US citizen and at least 65 years old then you are eligible for
Medicare. A legal permanent resident for the past five years also qualifies.
Medicare also covers some people below the age of 65 who are disabled. People
who get Social Security disability insurance usually qualify for Medicare after
waiting for 2 years. However, people with end-stage renal disease (permanent
kidney disease) automatically enroll after registration and people with
amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig's disease) qualify
as soon as they become disabled.
Registration
for Medicare
If
when you turn 65 you have been receiving Social Security benefits, you will be
automatically enrolled in Medicare Part A, which covers hospital costs, and
Part B, which pays for doctor visits.
You
must enroll yourself if you want Medicare Part D coverage as it is not
automatic.
If
you don't get Social Security benefits, you can enroll for Medicare via the
website of the Social Security Administration. You generally have to do this
within the seven-month window of your 65th birthday (which includes three
months before and after your birthday) to avoid the penalty and waiting a long
time for your insurance to begin.
If
you need Medicare Supplemental Insurance or Medigap, you need to sign up within
the Medigap enrollment period of 6 months, which begins the month you turn 65
and enroll in Medicare Part B. Private insurance that provides plans for
Medigap should guide you if you register at that time. Aside from that, a Medigap
plan may be sold to you, or you may be charged a higher fee for the plan.
Enrollment
period
You
will be enrolled automatically in Medicare Part A and Part B if you are
eligible because of a disability or when you become 65 years old, or if you
have already applied for Social Security. Aside from that, you can register on
your own if you so desire. Here's when to do so:
Early
enrollment period: If you cannot enroll automatically in Medicare, there will
be an early enrollment period that will last around your 65th birthday for
seven months: three months before and after your birthday month, including the
month of your birth. If your birthday is on the first day of the month, the
aforementioned period will include 4 months before the month of birth and two
months after the month of birth.
General
enrollment period: If
during the initial enrollment period you did not apply for Medicare, you must
wait for the general enrollment period of Medicare, which runs from January 1
to March 31 of each year. The insurance kicks in from the month after your
registration, and you may have to pay the late fee.
Special Enrollment Period: This is when you are permitted to enroll in Medicare or change insurance based on certain life circumstances, such as moving out of the coverage area or quitting a job.
There
is an annual Medicare open enrollment program that allows you to change your
coverage later. It lasts from October 15 to December 7 every year. If you have
Medicare Advantage, you can switch during the open enrollment period for Medicare
Advantage from January 1 to March 31 every year.
Medicare
Benefits
Compared
to primary Medicare, there may be benefits if you choose the Medicare Advantage
plan.
The
options are simple
Original
Medicare only has two types of insurance: medical insurance and hospital
insurance. If you need additional coverage, you may need to purchase Medigap
for supplemental coverage and Medicare Part D for prescription drug coverage.
Under
the Medicare Advantage plan, the entire coverage options you have are in one convenient
policy.
Customized
plan
Medicare
Advantage offers a variety of plans that are unique to your health condition.
For instance, the SNP Advantage plan can help with your medical expenses if you
have a serious illness.
A PFFS or PPO plan may be exactly what you are looking for if you desire provider freedom. Most Medicare Advantage plans cover additional services such as vision, dental, or hearing care if you need them.
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Saving
Cost
Most
Advantage plans have no premiums and provide no deductibles or low premiums.
Another advantage of Medicare Advantage is that many policies have a limit on
the maximum amount you will pay during the plan year out-of-pocket.
Also,
research from trusted sources shows that by switching to a Medicare Advantage
plan you can save money on lab services and medical supplies. You'll get more
savings on health care services offered by your HMO network if you choose a
Medicare HMO plan.
Integrative
medicine
Many
Medicare Advantage policies include coordinated health care. This means that
your doctors are constantly talking to each other to coordinate your healthcare
on different types of special treatments and medical services. This guarantees
that you have a healthcare team and helps avoid unnecessary complications and
expenses such as drug interactions.
Researchers
have found that coordinated healthcare was associated with patient satisfaction
and improved clinical staff performance.
2 Comments
Very Helpful for me thanks
Jack
April 15, 2023 at 6:21 PM
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Is very good
W.M.L.A
May 24, 2023 at 2:57 AM
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