Everything You Need to Know About Medicare

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Medicare is a federal program providing health insurance managed by Centers of Medicare and Medicaid Services. It has been around since 1966 and has about 30 to 35 private insurance companies affiliated with it.

9. Who is eligible for Medicare?

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Medicare and Medicaid services are only meant for United States citizens. You can be a part of Medicaid if you are a legal permanent resident of United States for five years or more.

Medicare is available to citizens above the age of 65 years. In some special disability cases, a person can be considered for Medicare even if he is below 65.

In case a person has end-stage renal disease, which needs regular dialysis or kidney transplant, they can opt for Medicare at any age. A person can also select Medicare anytime if they have Lou Gehrig’s disease or amyotrophic lateral sclerosis.

8. How does Medicare Work?

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There are many parts to a Medicare plan. When you are eligible for Medicare, you can get your health coverage through a government-run program or a privately run Medicare Advantage Plan.

You are automatically put on the federal-run Original Medicare plan as soon as you become eligible for Medicare by virtue of:

  • Turning 65
  • Medicare-eligible disability enrollment
  • End-stage renal disease which needs dialysis or kidney transplant, or
  • Lou Gehrig’s disease

Original Medicare is very different from a Medicare Advantage plan. There are many parts to how Medicare works. Medicare Part A and B together form Original Medicare. It covers the basics.

If you need something more in terms of cover, then you need to select from Medicare Part C, Medicare D, and Medigap or Medicare Supplement Insurance. Here is a breakdown of all Medicare options.

7. What does Medicare Part A cover?

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Medicare Part A can either be premium free or with a premium once you turn 65 years of age, depending on the years of work you put in. If by age of 65, you have worked for at least 10 years and paid Medicare taxes under Medicare-covered employment, then you automatically become eligible for premium-free Medicare Part A.

You can still enroll yourself in Medicare Part A after the age of 65 by paying monthly premiums. In case your spouse is eligible for premium-free Medicare Part A because of his or her work history, then there is a chance that your Medicare Part A enrollment could also be premium free.

Medicare Part A covers an array of services, such as skilled nursing, inpatient hospital and even home health care and hospice in some cases. However, it might come as a surprise to you that the extent of services does not cover every medical bill, but merely the basics.

Medicare Part A does not cover long-term care even when you need it. The care which you would be eligible for under Part A is very different from the care you would receive if you enroll yourself in a long-term facility or nursing home.

Medicare Part A cover does not include nursing care, which you might need. Even if skilled nursing facility care is covered, it is only limited to bare minimum personal tasks such as bathing and eating.

Certain home health services can be included in Medicare Part A coverage such as occupational therapy, speech therapy, speech-language pathology, and physical therapy.

You can be eligible for hospice care under Medicare Part A, if your doctor deems it necessary. This is usually in cases where a person is either terminally ill or has less than six months to live.

The hospice care, if approved, includes many care services such as doctors and nurses. It also includes physical and occupational therapy services and other hospice aid services. Symptom control prescription drugs and limited short-term respite for caregivers might also be included.

It is important for you to know that apart from the premiums, your Medicare Part A can come with additional costs such as copay, coinsurance, and deductibles.

Where Medicare Part A deals largely with inpatient and terminally ill people, Medicare Part B takes care of necessary outpatient services.

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