The 1960s was a time of radical change in American civil society and politics. In 1965, President Johnson signed the bill that brought Medicaid and Medicare to life. Over time, succeeding administrations made changes to these programs. For example, in 1972, the government extended coverage to other demographics and added more benefits to the program. To add to this, while the original plan only has Part A and Part B, there are now additional parts managed by private insurance.
Unlike many other government benefits, qualifying is fairly easy. Generally speaking, beneficiaries must be U.S. citizens or they must have attained permanent legal resident status five or more years prior. In addition to this, these groups may become eligible for benefits:
People who are 65 years or older may automatically become enrolled in this program, while others may need to apply.
Some younger people with disabilities and serious illnesses, such as kidney failure, may also sign up for benefits. Waiting periods may vary.
For the most part, people who receive Social Security Disability Insurance tend to qualify for Medicare plans after two years.
One of the biggest confusions surrounding this government program is what it covers and does not cover. Confusion also arises when it is compared to Medicaid. It’s important to note that Medicare plans are part of a federal health insurance plan that serves seniors and the disabled. In contrast, Medicaid is an income-based federal health program.
These are some of the most important things you should note federal health insurance does not cover
This covers the cost of short-term hospitalization or inpatient care at a nursing facility. It may also cover some of the expenses related to hospice care and home health care. Along with demographic factors, people who have worked long enough and paid taxes generally qualify. If you or your spouse paid at least 10 years of taxes into the program, then you should pay nothing. Otherwise, monthly part A costs could reach $471 per month. It’s also worth noting that Part A has a deductible, which is around $1,481 for 2021. It may also have coinsurance.
Part B generally requires a monthly premium, but the final dollar amount depends on the income level of the person applying. Premiums may start at $148.50 and become more expensive for married couples with adjusted gross incomes over $176,000 and single persons with adjusted gross incomes over $88,000. The current deductible is $203.
You can refuse Part B when applying for benefits. However, it may cost more to get it at a later date. If you do opt into Part B, it pays for a wide range of health care services, such as the following:
Private insurance companies can offer simpler and bundled health insurance plans that include Part A, Part B and a few add-ons. These include dental, vision and hearing. Sometimes, Part D is also included in these plans. Advantage plans are only available in specific areas and may be structured as PPOs or HMOs.
Also provided by private insurance companies, this addition pays for prescription drugs people may need. These include drugs for preventative care and treating illnesses. The average monthly premium for this benefit is around $33.
Medigap (Supplemental)
When health insurance costs are still insanely high, people may look to supplemental insurance from private companies. These assist with covering out-of-pocket expenses, such as deductibles, coinsurance and copayments.
The different parts of Medicare may come with different requirements. They are also administered by different entities, but they come together to create a comprehensive health care solution for seniors and people with serious disabilities.
People who turn 65 tend to become automatically enrolled in Part A and Part B if they were receiving Social Security benefits. Automatic enrollment does not include any additional parts. People who are not automatically enrolled will need to sign up around their 65th birthday. In fact, the Social Security Administration allows seniors to begin the signup process as early as three months before and anytime during the birthday month. Note that signing up more than three months after the birthday month could lead to permanent penalties.
To get a Medigap plan, it’s important to sign up the month you turn 65 or five months after your birth month ends. Private insurance companies are only required to accept Medigap applications during this time, but they may refuse applicants afterward.
At HealthPlans.com, we help qualifying individuals compare plans, so they can access benefits at affordable prices.
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