Benefits of Medicare Health Insurance

Benefits of Medicare Health Insurance

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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.

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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.




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.



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