What You Need To Know About Medicare

The older you become, the more you rely on insurance. As a senior citizen, finding a good insurance plan is challenging. There are many medical conditions which either only affect senior citizens, or are more likely to occur because of your vulnerable state. As you age, your immune system weakens, so not only do minor conditions take longer to recover from, but they also do more damage to your body. With proper medical care, you can take care of your body, but medical costs quickly add up if you do not have a good insurance plan.

Fortunately, there are multiple insurance plans designed for senior citizens. This is important because many private insurance agencies charge more based on your age, since you are considered higher risk. The gold standard for senior health insurance is the federally run program, Medicare.

Types of Medicare Coverage

Medicare provides excellent and affordable insurance for senior citizens, but it is also one of the more complicated insurance programs. Medicare is not a single insurance plan. Instead, it is divided into four optional parts. These parts are known as Medicare Parts A-D. Each part covers different areas, though there is some crossover. Each of the parts has their own insurance payments, including co-pays, premiums and deductibles.

Medicare Part A provides coverage for impatient hospital care. This includes costs for nursing facilities or retiring to an assisted living community. Hospice care is also covered by Part A. Part A also includes insurance for general health services, such as your yearly screenings and doctor visits.

Part B focuses on the costs of outpatient services, like specialized medical equipment. Part B covers some generalized health services like Part A, but it focuses much more on preventative care. Part C, also known as Medicare Advantage, shares many elements with Parts A and B, but it is provided through a private insurer. This allows you to customize the plan and only pay for the coverage you need, but there is much more haggling and negotiating with the insurance provider.

Medicare Part D is a specialized healthcare plan focused solely on prescription drug costs. Part D uses a coverage gap, which determines how much money you must pay out of pocket. Once you hit the coverage gap, Part D covers the rest of your prescription costs.

Medicare Eligibility Requirements

Medicare eligibility is determined by the plan you are applying for. There are some general requirements consistent across all the parts. No matter what the plan, you must be at least 65 years of age to apply. For most seniors, Medicare Part A is the easiest coverage to get. The majority of senior citizens are automatically eligible for Part A coverage. As long as you paid Medicare taxes for at least 10 years, are eligible for Social Security retirement or collect Railroad Retirement Benefits, you are eligible for free Part A coverage. If you do not meet any of these base requirements, you are still allowed to apply for Part A coverage, but you do not get it for free.

Medicare Part B has the same base set of eligibility requirements, but you cannot get free coverage. For the most comprehensive coverage, healthcare experts advise getting both Parts A and B, especially if you get part A coverage for free.

Medicare Part C does not have set eligibility requirements. When you meet with a private insurance agency to discuss Part C, the company is allowed to set their own requirements. In most cases, insurance providers make Part C accessible to encourage seniors to purchase private insurance instead of getting Parts A or B.

Because Medicare Part D is an add-on insurance plan, there are no special requirements. As long as you are eligible for general Medicare coverage, you can apply for Part D.

Applying for Medicare

In addition to understanding the different plans and eligibility requirement, you must pay careful attention to the application dates. You can only apply for Medicare during set points, known as enrollment periods. There are two types of enrollment periods, annual and initial. Several months before you turn 65, you will receive a Medicare pamphlet in the mail. The pamphlet details information about each enrollment period, including the earliest time you can submit your application. This is your initial enrollment period. Also included in the pamphlet is whether you are eligible for free Part A coverage.

The annual enrollment period refers to the period where any senior citizen applies for coverage. The annual enrollment period begins October 15th and runs until December 7th each year. If you already have Medicare and want to remove or add an additional plan, you can make the request during the open enrollment period.

If you recently had insurance from another source, such as an employer you no longer work for, you are eligible for a special enrollment period. This gives you a small window to apply for Medicare outside of the previous enrollment periods. Other extenuating circumstances, such as a drastic change in your health, may also grant you access to the special enrollment period.