In the United States, Medicare is a national social insurance program, administered by the U.S. federal government since 1966, currently using about 30 private insurance companies across the United States.
Medicare provides health insurance for Americans aged 65 and older who have worked and paid into the system. It also provides health insurance to younger people with disabilities, end stage renal disease and amyotrophic lateral sclerosis.
In 2010, Medicare provided health insurance to 48 million Americans—40 million people age 65 and older and eight million younger people with disabilities. It was the primary payer for an estimated 15.3 million inpatient stays in 2011, representing 47.2 percent ($182.7 billion) of total aggregate inpatient hospital costs in the United States. Medicare serves a large population of elderly and disabled individuals. On average, Medicare covers about half (48 percent) of the health care charges for those enrolled in Medicare. The enrollees must then cover the remaining approved charges either with supplemental insurance or with another form of out-of-pocket coverage. Out-of-pocket costs can vary depending on the amount of health care a Medicare enrollee needs. They might include uncovered services—such as long-term, dental, hearing, and vision care—and the supplemental insurance.
What is Medicare?
Medicare is health insurance that covers certain medical expenses. It has deductibles and co-insurance.
Who is it for?
Individual 65 and over, persons under 65 receiving Social Security disability for 24 months, and certain individuals with end stage renal disease.
What are the “4 parts" of Medicare? What do they cover?
- Part A – Helps pay for hospital and other inpatient stays. Medicare Part A has a hospital deductible for each inpatient stay. The deductible for 2015 is $1260 per admission.
- Part B – Helps pay for doctors and other outpatient services, such as labs and x-rays. Part B has a deductible and coinsurance for doctor and other outpatient services. The annual Part B deductible for 2015 is $147. Medicare then pays 80% of allowed charges leaving you with the 20%. Medicare does not have a dtmit to the 20% you pay. Medicare Supplement plans cover some or all of these deductibles and coinsurance amounts.
- Part C – Medicare Advantage Plans – Plans approved by Medicare offered by private insurance companies that cover all Medicare services. Some offer prescription drug coverage and extra benefits such as dental and vision. Plans are usually HMO or PPO type plans. They may include copays, coinsurance and out of pocket dtmits. Talking with a dtcensed professional can help you decide if this is a good option for you.
- Part D – Helps pay for prescription drugs. Offered by private insurance companies approved by Medicare, may have deductibles and copays.
What does it cost?
- Part A – You usually don’t pay a premium for Part A if you or your spouse paid Medicare taxes while you were working.
- Part B – You do pay a premium for Part B each month. Most people pay $104.90 per month. This is usually deducted from your monthly Social Security benefit payment. Premiums could be higher depending on your income.
- Part C – Medicare Advantage Plans. Premiums for these plans are determined by each insurance carrier.
- Part D – You do pay a monthly premium for Part D prescription drug plans. The amount you pay is based on the plan you choose. Premiums could be higher depending on your income.
When can I enroll?
Automatic Enrollment in Medicare
If you are currently getting Social Security benefits you will get Part A and Part B automatically starting on the first of the month you turn 65. Your Red, White, and Blue Medicare card usually arrives about 3 months before your birthday.
Note: If you have not started taking your Social Security payments, but plan on starting them, you must contact Social Security. At this time you may also enroll in Medicare. You may call Social Security, go to your local Social Security office, or enroll online.
You’re Not Automatically Enrolled …. If you are not getting or plan on delaying your Social Security benefits.
You can still enroll in Medicare during the Initial Enrollment Period – This is the 7 month period beginning 3 months before you turn 65, the month you turn 65 and 3 months after your turn 65. Your effective dates are determined by when you enroll. Medicare will bill you quarterly for your Part B premium.
Special Enrollment Period
If you didn’t enroll when you were first eligible because you were covered under a group health plan and the plan ends (for example you’re covered by an employer group plan and you stop working), you have 8 months to sign up for Part A and Part B.
Enrollment in Part C or Part D is not automatic. If you want either of these you must enroll with the insurance carrier of the Part C or Part D plan you want. A licensed insurance agent can assist with enrolling.