When Is Medicare Available to You?

This federal health insurance plan is available to you if you are age 65-years or older. There are some instances where this insurance is available to younger persons. You must be diagnosed with a disability, end-stage renal disease, on kidney dialysis or need a kidney transplant. Your coverage for this plan has no set income levels. Other stipulations for receiving this insurance is you must be a United States citizen or a legal resident who has lived in the US for at least five years. If your income is severely limited you have the option of applying for Medicaid.

The Two Main Parts

The original Medicare, a fee for service program has two parts, part A, and Part B. Part A covers hospital charges for inpatient hospital stays, surgical procedures, hospice care, skilled nursing facilities for 20 days, and in special circumstances covers limited in-house nursing care.

Part B covers outpatient medical coverage such as visits to see your doctor. outpatient care, medical equipment, and supplies, blood tests, X-rays, diabetic screenings and diabetic supplies, preventive services are limited.

Two More Parts Added

This senior insurance now offers Parts C and D. Part C provides an alternate way to receive Medicare benefits, and Part D provides prescription drug coverage. Premiums are taken directly out of your Social Security check every month.

If you have Part A the law states you are covered for hospital stays, thus you do not need to buy an additional health insurance plan. If you do not have Part A but have Part B you do not have health coverage and will have to buy a plan.

This Retirement Insurance Pays Only a Percentage

Everyone pays the same amount for the original Parts A and B. $135.50 automatically comes out of every Social Security check every month and seems to go up a few dollars every year. Depending on your Social Security awarded, some plans require zero co-pay. Some plans require $10.00 for a primary care doctor visit and $50.00 for a specialist visit, some zero. Depending on what else you want to buy this monthly amount can be more and can also be deducted directly from your Social Security check.

This insurance only pays for 80 percent of all medical bills. You must pay the remaining 20 percent unless you have an additional insurance plan such as Blue Cross Blue Shield. This plan does not pay for long-term custodial care, dental care, or routine eye exams. If you have a medical diagnosis related to your eyes Medicare pays for these eye exams and treatments. Medicare does not pay for glass frames or glass lenses.

The Choice of Coverage is Yours

You can choose Part A and B only or an Advantage Plan which is an HMO or PPO plan. You must decide if you want Part D to cover prescriptions. If you do not choose Part D in the beginning and you pick up Part D later there is a penalty you pay every month. You have the option of choosing a stand-alone visual and dental plan and a stand-alone health insurance plan such as Blue Cross Blue Shield. Your medical bills are deducted from Medicare first and then billed to your stand-alone insurance policy.

Part C

You have the option of replacing Parts A and B with an insurance plan through a private company but they must offer the same coverage in addition to hearing aids, dental care and more.

An Advantage Plan adds increased security such as combining medical and Part D coverage in addition to vision, dental and hearing services. An Advantage plan usually cost less and covers more.

The prescription drug plan does have limits on what the pharmacy charges, meaning that if you are allowed $6,000 per year and in June you spent $6,000, you must pay out of pocket for the rest of the year the entire cost of each drug you take.

Remember that the only time you can change your health insurance plan is from October 15th through December 7th each year. This is called open enrollment where you recieve your new Medicare cards. If your city has a Department on Aging, this agency helps you to pick the right plan for you. They have a wonderful Medicare Health Support system.

There are a wide variety of other federal plans such as Part E, F, G, and more. Access Medicare.org or MedicareHealthSupport.org for all plans and definitions beyond Part A, B, C, and D.