Topic: Medicare and Medicaid
Medicare is a federally sponsored program providing health insurance for people who are 65 or older, or for people who are under the age of 65 with certain disabilities. Medicare provides individual coverage only, and each spouse must be covered separately.To be eligible for Medicare one must be a U.S. citizen or a legal permanent resident of the U.S. for at least 5 continuous years, at least 65 years old, or if under age 65, receiving Social Security Disability Insurance (SSDI) benefits for at least 24 months, or have end stage renal disease (ESRD), or Amyotrophic Lateral Sclerosis (ALS), more commonly known as Lou Gehrig’s Disease. There are no income or asset requirements, so everyone who meets the eligibility requirements above is entitled to Medicare coverage. People who meet these requirements and who are receiving Social Security benefits when they turn 65 are automatically enrolled in Parts A &B of Medicare; however, if you are not receiving social security benefit you must enroll during one of the Medicare enrollment periods.
There are two ways to have Medicare coverage: Original Medicare or Medicare Advantage. You cannot have both at the same time.
Original Medicare consists of 4 separate programs, and the type of coverage that you have depends on enrollment in that program. Part A helps pay for hospital costs, very limited skilled nursing, and hospice care. Part B pays for doctors, diagnostics, laboratory, and other outpatient care. Part D helps pay for prescription drugs. In addition, private insurance policies known as a Medicare Supplement or Medigap Policy can be purchased to pay for some or all of the deductibles and copays that are not covered by Parts A & B.
Medicare Advantage consists of private health plan options, run by private companies, that are approved by Medicare to provide health insurance to members. Many plans offer extra benefits not covered by Original Medicare. Most plans are HMOs or PPOs. You must be entitled to Part A and enrolled in Part B, live in the plan’s service, area, enroll in the plan, and you cannot have ESRD at the time of enrollment unless you no longer require dialysis