Medicare is normally available to United States citizens who are age 65 plus . Not all people on Medicare are those over the age of 65 - it is sometimes available to certain long term Social Security Disability Beneficiaries who are under age 65 as well.
For those who qualify for Social Security Disability Insurance (SSDI), these can generally then also qualify for Medicare Parts A and B after 24 continuous months of receiving such assistance. Medicare disability enrollees are generally entitled to the same basic benefits as traditional age 65-plus Medicare enrollees. There are significant gaps in Medicare coverage that can often be filled by private Medicare Supplement (MediGap) plans, or by Medicare Advantage plans. Medicare Part A and B benefits are listed below.
Medicare Part A is commonly considered the Hospital Insurance portion and covers services considered to be medically necessary such as inpatient hospital care, critical access care, short-term care in skilled nursing facilities, hospice and home health care. Medicare usually does not pay for long-term care at home, in assisted living facilities, or at nursing homes. Medicare Part A is free to most Medicare beneficiaries if the beneficiary or their spouse paid Medicare taxes while they were working 40 quarters/10 years or more. Even if an individual is not eligible to receive Part A free of cost, the individual may be eligible to purchase Part A coverage if they meet certain eligibility requirements.
Medicare Part B is referred to as Medical Insurance, and Part B covers medically necessary services such as doctor and outpatient care. Part B does cover some preventive services. Additionally, some occupational and physical therapies may be covered by Medicare Part B.
Unlike Part A, Part B coverage does require a monthly premium. While standard premium amounts do exist, premiums can be higher for some beneficiaries than others. This is because Part B premiums may be based on beneficiary income.
It is important to remember that Part B is not a 100% insurance coverage plan, and beneficiaries will be responsible for the balance of expenses not paid by Medicare and not all medical services are covered.
Medicare Part C, otherwise known as Medicare Advantage plans are private health insurance plans approved by Medicare. You may opt to get your Part A, B and D benefits from a Medicare Advantage plan instead of traditional Medicare. These Medicare private insurance plans usually have an HMO, POS or PPO network of doctors.
Medicare Part D is simply insurance for your prescription medication needs. You will pay a monthly premium to a private insurance carrier. You then would use one of the insurance company's network of pharmacies to purchase your medications. Instead of paying full retail cost of the medication, you will jjust pay a smaller copay or percentage of the drug’s cost. The insurance company will pay the rest.