Understanding Medicare: Coverage and Eligibility

Medicare is a federal health program for people who are aged 65 or above, and for people younger than 65 under certain conditions. The program helps to cover some important medical costs and services. However, the beneficiary still has to pay premiums, deductibles, and copayments, which vary depending on the plan.

To qualify for Medicare, you must be 65 years or older and must be a United States citizen or a permanent resident for at least five years. People who receive Social Security disability benefits also qualify for Medicare after receiving the benefits for at least 24 months. People with health conditions such as End-Stage Renal Disease and Amyotrophic Lateral Sclerosis also qualify for Medicare automatically.

Parts of Medicare

There are different parts of Medicare. Original Medicare is divided into two parts – Medicare Part A and Part B. Medicare Part C is known as Medicare Advantage. Medicare Part D offers prescription drug coverage. And, Medicare Supplement plans help to cover some of the costs associated with Original Medicare.

Medicare Part A

Medicare Part A covers inpatient hospital care. The plan also covers skilled nursing facility care, some home health services, and hospice care. Most people do not have to pay premiums for Medicare Part A if they have paid up to 40 quarters, or ten years, of Medicare taxes while they were employed.

Medicare Part A is also premium-free for people who receive Social Security benefits who have paid the necessary Medicare taxes. If you do not meet the requirement, then you can get Part A for a monthly premium which varies depending on the amount of Medicare taxes you have paid.

Medicare Part B

Part B covers outpatient medical services such as preventive screenings, doctor visits, lab tests, mental health services, ambulance services, and durable medical equipment such as canes and walkers. Unlike Part A, Part B premiums are typically required and are adjusted each year. For those with a high income, the premiums may be higher. There is also an annual deductible for Part B and after meeting the deductible, you will pay about 20% of the approved amount for doctor services and other costs.
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Enrollees who failed to register when they were first eligible will pay a late enrollment penalty.

Medicare Part C

Medicare Part C is also known as Medicare Advantage. It is offered by private insurance companies that have been approved by Medicare. The plans must provide the same coverage as Original Medicare, but often offer additional benefits such as prescription drug coverage and routine dental and vision care.

Medicare Part D

Part D offers prescription drug coverage and is provided by private insurance companies. You can enroll for Part D if you have Original Medicare. You can also enroll in a Medicare Advantage plan that offers prescription drug coverage.

Medicare Supplement Plans

Medicare Supplement plans help to cover the out-of-pocket costs associated with Medicare Part A and Part B. There are 10 standardized Medicare Supplement plans that each have a standardized coverage amount for expenses like deductibles or coinsurance.

If you wish to know more about your Medicare options in Oregon, reach out to us today!