MC

A federal health insurance scheme/program for those “65 years of age or older” is called Medicare (MC). Medicare (MC) may also be available to individuals “under 65” who have specific disabilities, end-stage renal disease (ESRD), permanent kidney failure, or amyotrophic lateral sclerosis (ALS, commonly referred to as Lou Gehrig's disease).

Depending on whether you begin receiving Social Security “retirement or disability” benefits before the age of 65, you may need to voluntarily enroll or “you may be eligible for Medicare (MC) automatically.”

You will need to enroll/sign-up in Medicare (MC) if you wish to receive coverage when you turn 65 but do not intend to draw “retirement benefits” at that time. Also, you may wish to wait to enroll in Medicare as soon as you are eligible, depending on “whether you are employed” and whether your employer provides health insurance.

If, at least four months prior to turning 65, you intend to receive Social Security “retirement or disability” (or the Railroad Retirement Board (RRB)) payments/advantages. Then on this happening, when you turn 65, Medicare (MC) “Part A” (hospital insurance) and “Part B” (medical insurance) are automatically granted to you. Important choices regarding “how to accept coverage” (with or without additional coverage, such as drug coverage) will still need to be decided.

After receiving “disability benefits” from Social Security (or the RRB) for 24 months, recipients of those benefits will automatically be enrolled in Medicare (Parts A and B). Furthermore, the month your “disability benefits” start, you will immediately receive Parts A and B if you have Lou Gehrig’s disease, generally known as ALS.

Medicare (MC) does not provide plans for “families or couples,” which sets it apart from private insurance. You and your partner are not required to choose the same option.

Each form of health insurance you have, whether it be “Medicaid, retiree coverage, group health plans, or Medicare,” is referred to as a “payer.” The “coordination of benefits” laws determine who pays first when there are many payers.

The MC program/scheme assists with some medical costs, but not “all medical bills or the majority of long-term care costs” are covered.

Medicare Coverage -

You have options on how you receive Medicare (MC) coverage during “your first sign up” and “specific times of the year.” Original Medicare and “Medicare Advantage” plans are the two basic methods to acquire Medicare (MC). In addition, “Medicare drug coverage” or “Medicare Supplement Insurance” (Medigap) are examples of supplemental insurance that certain people need.

Medicare Advantage (previously referred to as Part C)

“Medicare Advantage” is a health and drug plan from private organization that has been approved by Medicare (MC), and provides an option to “Original Medicare” for those who choose it. Also, you will typically have to use physicians or hospitals that are part of the plan’s network.

It covers all services and benefits provided by Parts “A and B.” Also, the majority of “Medicare Advantage” plans cover “prescription drug” (Part D) coverage. Plans may provide certain additional benefits, such as “dental, vision, and hearing care,” that Original Medicare does not cover. Plans might be less expensive out of pocket than “Original Medicare.”

Medicare (MC) still covers several health plans that aren’t “Medicare Advantage” Plans. Examples include the Medicare Cost plans, the “Program of All-inclusive Care for the Elderly” (PACE), and Demonstration/Pilot programs.

Here, plans have an annual cap on the amount of money you have to pay out of pocket for services that “Part A and Part B” include.

For more information, visit — “medicare.gov/health-drug-plans/health-plans/your-health-plan-options”.

Note: Before enrolling in a Medicare Advantage plan, inquire about the policies of your “company, union, or other benefits provider.” You may occasionally lose your “work or union insurance” when you enroll in a Medicare Advantage plan. If you lose, your spouse and any dependents may also lose coverage.

Original Medicare

Medicare (MC) Parts “A and B” (Hospital Insurance and Medical Insurance) are included in Original Medicare. Also, enrollment in Original Medicare is managed by “Social Security.” Further, Original Medicare is what you have if you get your “Part A and Part B” benefits straight from the government. You have a Medicare Advantage plan if your benefits are provided by a Medicare Advantage organization or “another private company” (having Medicare approval).

Most prescription drugs are not covered by “Original Medicare,” with a few notable exceptions. “Prescription drug” (Part D) coverage under Medicare is available for addition to all Original Medicare beneficiaries. In order to reduce your out-of-pocket expenses, you can also get “supplemental” coverage from a private firm.

Any “physician or facility/hospital” in the United States that accepts Medicare is available to you. It is not necessary to select a “primary care doctor” for Original Medicare.

Here, the amount you pay out of pocket is never capped, provided you have no “additional insurance,” such as Medicare Supplement Insurance (Medigap).

Medicare “Part B” enrollment requires a monthly premium payment from everyone who qualifies for “Part A” at no cost.

You may be able to purchase a Part A if you are not eligible for a “premium-free one.” To purchase Part A, you must also enroll in Part B.

For more information, visit — “medicare.gov/what-medicare-covers/your-medicare-coverage-choices/how-original-medicare-works”.

Note: You may be able to purchase a Part A if you are not eligible for a “premium-free one.” You may be penalized if you choose not to purchase Part A when you “first become eligible” for Medicare, which is often when you reach 65. Also, you might have to pay more to obtain Medicare “Part B”, “prescription drug coverage” or “Medigap” later on if you don’t acquire it when you first become eligible.

Prescription Drug coverage (Part D)

Prescription drug costs are somewhat covered by “Part D” (prescription drug coverage) under Medicare (MC). All Medicare beneficiaries are eligible to enroll in a “prescription drug” plan, which is optional and requires an extra monthly premium. If you do not have a Medicare “private fee-for-service” (PFFS) plan, Part D coverage can be “obtained as an independent plan” or integrated into Medicare Advantage.

Medicare (MC) “prescription drug” coverage can be obtained in two ways:

With Medicare health plans that have “prescription drug” coverage included (such as the Medicare Advantage plan). Also, Prescription drug coverage is not a feature of every “Medicare Advantage” plan.
With Medicare drug plans that supplement/add “prescription drug” coverage to “Original Medicare, some Private Fee‑for‑Service plans, some Medicare Cost plans, and Medical Savings Account plans.”

You can enroll in an independent Medicare “prescription drug” plan/coverage if your current plan doesn’t provide prescription drug coverage (some Private Fee-for-Service plans) or can’t provide prescription drug coverage (such as Medical Savings Account plans). Further, you will be reverted back to Original Medicare if you enroll in a separate prescription drug plan while enrolled in a “Preferred Provider Organization, HMO Point-of-Service plan, or Health Maintenance Organization.”

For more details, visit — “medicare.gov/drug-coverage-part-d”.

Extra Help

Medicare (MC) offers a program called “Extra Help” to assist those with low incomes and resources in covering Part D (prescription drug) costs (such as coinsurance, deductibles, and premiums). Typically, these resources and income thresholds are updated annually.

Furthermore, when receiving “Extra Help,” there will be no Part D late enrollment penalties.

If you have Medicare and satisfy one of the following requirements, you are “automatically eligible” and do not need to apply for Extra Help:

Possess Social Security “Supplemental Security Income” (SSI)
Possess Full Medicaid coverage.
Receive “Part B” premium assistance from your state (via a Medicare Savings Program).

It is possible to apply for Medicare Savings Programs (MSPs) and “Extra Help” simultaneously.

As of June 2024 information, there is no “Extra Help” offered in “American Samoa, Puerto Rico, Guam, the Northern Mariana Islands, or the U.S. Virgin Islands.” However, there are “additional services” in those places for persons with low incomes and resources. Contact your state Medicaid office for more assistance.

For more information, visit — “medicare.gov/basics/costs/help/drug-costs”.

Medicare Supplement Insurance (Medigap)

To assist with covering your “portion” of the out-of-pocket expenses associated with “Original Medicare,” you can purchase Medicare Supplement Insurance (Medigap) from a private insurance provider. “Coinsurance, deductibles, and copayments” are among the expenses that Medigap pays for but Medicare (MC) does not.

Only those with Original Medicare (i.e., Parts A and B) are eligible to purchase “Medigap.” Every Medigap policy is the same. This implies that regardless of “where you live” or the insurance firm you purchase the policy from, plans with the same letter provide the same fundamental benefits. The majority of states offer ten distinct Medigap plan categories, denoted by the letters “A–D, F, G, and K–N.”

Prescription medicines, dental, vision, hearing aids, private-duty nursing, and “long-term care” (like care in a nursing home) are typically not covered by Medigap plans.

You could “have to pay extra” or not be able to purchase a Medigap policy if you’re below 65 years old.

Beginning in the month that you turn 65 or older and have Medicare Part B, you are eligible for Medigap enrollment in a “six-month period” (known as ‘Medigap Open Enrollment’ period). Medigap Open Enrollment period is available/opened once for your enrollment. It is not recurrent annually, in contrast to the “Medicare Open Enrollment” period. You might not be able to purchase a Medigap plan beyond this Medigap period, or it might cost more.

For more details, visit — “medicare.gov/health-drug-plans/medigap/basics”.

Official Website of “Medicare”: https://www.medicare.gov/

That’s all friends.