Medicare is a federal health insurance programme for persons 65 years of age or older, as well as those under 65 who have specific disabilities or diseases. Some people with low incomes and resources can get health insurance through Medicaid, a combined federal and state programme.
What is Medicare?
The American government’s health insurance programme is called Medicare. The plan covers people over the age of 65, those with impairments, and those with end-stage renal disease.
Medicare consists of several programmes, some of which have a cost to the insured, that cover specific parts of medical care. While doing so enables the programme to give participants more cost and coverage options, it also makes the sign-up process more difficult.
How Medicare Functions
The U.S. government funds the national health insurance programme known as Medicare. To offer coverage for seniors 65 and older without health insurance, Congress amended the Social Security Act in 1965, creating the programme.
The Centres for Medicare and Medicaid Services (CMS), which now oversees the programme, has expanded coverage to include those under the age of 65 who have specific disabilities, end-stage renal disease, or amyotrophic lateral sclerosis (ALS), often known as Lou Gehrig’s disease, or amyotrophic lateral sclerosis.
There are four parts to Medicare, each covering a distinct area of healthcare.
- Medicare Part A is hospital insurance covering treatment at home, in skilled nursing facilities, and through hospice.
- Doctor visits, outpatient care, home health care, and durable medical equipment are all covered by Medicare Part B. and preventative exams.
- Medicare Part C, called Medicare Advantage, refers to Medicare-approved private insurance plans that typically offer Part A, B, and D benefits.
- Prescription medications are covered by Medicare Part D.
Who Can Receive Medicare?
Medicare coverage is generally available to anyone who has been a legal resident of the United States for at least five years and is 65 years of age or older, depending on various factors. Anyone who gets Social Security benefits is automatically enrolled in Parts A and B. It would help if you enrolled to be covered under Part D because it is an optional benefit.
If a person is under 65 and receives Social Security Disability Insurance (SSDI), they may be eligible. SSDI recipients must typically wait 24 months after receiving their initial check before being eligible for Medicare. The programme exempts those with ALS and chronic renal failure from this rule. Enrollment is possible on the Social Security Administration (SSA) website.
If the insured person or their spouse paid payroll taxes into Medicare for 10 years or more, their Part A premiums, which cover hospital stays and other inpatient treatment, are free.
Other facets of the Medicare programme need premium payments from you. Federal Insurance Contributions Act (FICA) payroll taxes are the primary funding source for the programme. Employees will be responsible for paying FICA payroll taxes beginning in 2022, which include a 6.2% Social Security tax on wages under $147,000 ($160,200 in 2023) and a 1.45% Medicare tax on all taxable income. Employers cover the same percentage of each employee’s benefits.
Annual earnings over $200,000 for solo taxpayers and $250,000 for married couples filing jointly are subject to an extra 0.9% Medicare surtax.
How Does One Sign Up for Medicare?
You will automatically be enrolled in Medicare Part A, which covers hospital expenses, and Medicare Part B, which covers doctor visits, as long as you are eligible to receive Social Security benefits when you turn 65. There is nothing you need to do to sign up for these programmes. You must, however, sign up for additional Medicare programme components. Top Medicare websites like https://www.medisupps.com/ are beneficial.
You must enrol independently if you want Medicare Part D prescription drug coverage. You can register for this through the SSA website if you don’t currently get Social Security payments. Around your 65th birthday, you should do this within seven months. The three months before the month you turn 65, the month of your birthday, and the three months following your birthday month are all included in this timeframe. You can be penalised if you skip this window.
You must enrol independently if you want Medicare Supplement Insurance (Medigap). The six-month open enrollment period for this begins the month you turn 65 and sign up for Medicare Part B. If you enrol during this time, the private insurers that sell Medigap policies must give you coverage. There is no assurance that they will sell you a Medigap plan if this is false.
There are other yearly Medicare open enrollment opportunities if you miss your original enrollment window or switch plans later.
What Is Covered by Medicare?
As was already discussed, four kinds of Medicare programmes are offered to people. Parts A and B, or the Medicare Part C plan, provide most of the basic Medicare coverage. People may also choose to sign up for the Medicare Part D programme.
· What Is Covered by Medicare Part A?
Hospitals, skilled nursing facilities, hospices, and some home healthcare services are all covered by Medicare Part A. Long-term or custodial care is not, however, covered by this plan. Anyone who receives Social Security income is automatically covered. The SSA website allows enrollment for persons who do not receive benefits.
· What Is Covered by Medicare Part B?
Medicare Part B often pays for the costs of outpatient care, including trips to the doctor. Preventive services, ambulance transportation, specific medical supplies, and mental health treatment are also covered by Part B. This plan also covers some prescription medications.
Medicare Part B enrollees will pay an average monthly premium of $164.90 in 2023 instead of $170.10 in 2022. The annual deductible will drop from $233 in 2022 to $226 in 2023. However, taxpayers with modified adjusted gross income (MAGI) beyond the yearly cap pay a higher premium. These were $97,000 for single taxpayers and $194,000 for married couples filing jointly in 2021 MAGI for 2023. Based on 2020 MAGI, those numbers increased from $91,000 and $182,000, respectively, in 2022.
· What Is Part C of Medicare?
Part C, often known as Medicare Advantage, is available to those who qualify for Medicare Parts A and B. Instead of through Medicare, consumers buy Medicare Advantage plans from private insurers. The coverage provided by these plans must be at least comparable to Original Medicare (Parts A and B).
There are annual caps on out-of-pocket expenses in many Medicare Advantage plans. Many also offer extra services like copayments, deductibles, and even coverage for travel outside of the United States that Original Medicare users would otherwise have to obtain through supplemental insurance like a Medigap plan. Additionally, dental, eye, and hearing care may be included in some policies.
Although some Medicare Advantage plans offer hearing services as supplementary benefits, standard Medicare does not cover hearing aids.
· What Is Part D of Medicare?
Through Medicare Part D, Medicare provides supplementary prescription medication coverage. Medicare Part A or Part B beneficiaries may sign up for Part D to get financial assistance for prescription medication expenditures that Original Medicare plans do not cover.
Conclusion
The American government’s health insurance programme, Medicare, provides financial assistance for medical treatments. The plan covers ages 65 and over, younger persons who fulfil certain eligibility requirements, and people with particular disorders.
You will automatically be enrolled in Medicare Part A, which covers hospital expenses, and Medicare Part B, which covers doctor visits, as long as you are eligible to receive Social Security benefits when you turn 65. Once you are eligible, you can sign up for additional Medicare benefits.
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