Medicare
Made Simple

Are you Eligibile for Medicare?

Medicare is a health insurance program run by the federal government which helps eligible individuals with the high costs of healthcare. Medicare includes four parts, Part A, B, C and D, and each part covers a separate area in the health care system. There are three main conditions you need in order to qualify for Medicare benefits, and they include:

  1. (1) You must have paid taxes into the Medicare system for at least 10 years (usually automatically deducted from your paycheck)
  2. (2) You must be 65 years or older
  3. (3) You have a disability or permanent kidney failure

Medicare Part A covers hospital insurance which assists in the costs associated with inpatient care in a hospital, a skilled nursing facility (following a hospital stay), some home health care and hospice care. Most eligible individuals do not have to pay a premium for Part A because:

  1. (1) You receive or are eligible to receive Social Security benefits
  2. (2) You receive or are eligible to receive railroad retirement benefits
  3. (3) You contributed Medicare taxes when you were employed in a government job
  4. (4) You are the dependent parent of someone who worked long enough in a government job where Medicare taxes were paid

Medicare Part B covers medical insurance which helps pay for doctor visits, outpatient hospital care and other medical services which Part A does not cover. Any individual eligible for Part A can enroll in Part B by paying a monthly premium. In 2008, the monthly premium was $96.40 per month, and the cost of Medicare Part B can increase by 10% each year.
Medicare Part C is a Medicare Advantage plan, which incorporates several different plans in order to meet as many individuals’ needs as possible. You are eligible for Part C if you are currently enrolled in Medicare Part A and B. Due to the extra benefits Part C offers, most individuals have to pay a monthly premium. Typically, Part C plans have networks and you must use the doctors or hospitals that belong to the specific plan you chose. Medicare Advantage plans include:

  1. (1) Medicare Health Maintenance Organizations (HMO)
  2. (2) Medicare Preferred Provider Organization plans (PPO)
  3. (3) Medicare Private Fee-for-Service plans (PFFS)
  4. (4) Medicare Special Needs
  5. (5) Medicare Medical Savings Account (MSA)
Medicare Part D pertains to prescription drug coverage. Medicare Part D assists individuals with the high costs of prescription medication. Anybody enrolled in a Medicare Part A, B or C is eligible for Part D coverage. Enrolling in a Medicare Part D program is completely voluntary so there is a monthly premium which is to be paid to the insurance provider.
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