‘Medicare’ is a federal sponsored health insurance program for people who are 65 or older. It also covers certain younger people with disabilities and people with permanent kidney failure requiring dialysis or a transplant (sometime called ESRD or End-Stage Renal Disease). Medicare and Medicaid were both first created in 1965—are, however, not the same, two different plans. Medicaid is a state and federal program that provides medical care mainly for those who are in poverty.
Medicare has been designed in four different parts to cover specific services. They are:
- Part A
- Part B
- Part C
- Part D
Medicare works a lot like health insurance, except instead of private insurers, the government reimburses medical expenses to the doctors and hospitals. An individual entitles to this federal sponsored service when he becomes 65 or older or before that a patient with permanent kidney failure or ESRD.
“Part A” of Medicare is also known as ‘Hospital Insurance’. It covers most medically necessary expenses on hospital and home health care. It includes cost of skilled nursing facility and hospice care on fulfillment of certain conditions. It is free to every individual who is a lawful U.S citizen and has worked and paid Social Security taxes for at least 10 years or 40 calendar quarters and to an individual who has worked and paid for less time but has continued to pay his monthly premium for Part A regularly.
‘Part B’ of Medicare is also known as Medical Insurance. Part B covers two types of services—Medically Necessary Services and Preventive Services. These two parts cover most medically necessary preventive care, doctors’ services, durable medical equipment, laboratory tests, x-rays, hospital outpatient services, mental health care, and some home health and ambulance services. To maintain one’s eligibility, regular payment of monthly premium for this coverage is necessary.
‘Part C ‘is often termed as Medicare Advantage Plans or Medicare (+) Choice. It combines Part A, Part B and sometimes Part D coverage. An insured under this plan may build a custom plan that closely aligns with own medical need. Private insurance companies, or Medicare Preferred Provider Organizations (PPO) that is approved by Medicare or Health Maintenance Organizations (HMOs) are sometime invited to participate in this program but the details of the programs vary depending upon the program and eligibility of the eligible individual.
‘Part D’ is also known as Prescription Drug Plan because the plain aims to lower prescription drug costs and helps to protect against higher costs in the future. The plan enlists the names of the drugs that are covered under the plan. Part D is administered by one of several private insurance companies offering different plans at different costs. Participation in Part D requires payment of a premium and deductibles. The extent of benefit under the plan depends upon the premium you pay.
How to Apply for Medicare Part B
Unlike ‘Part A’, there is no compulsion under ‘Part B’ to pay certain number of contributions from wage to earn eligibility under the plan. If an individual is entitled to receive benefits from Social Security or the Railroad Retirement Board, in most cases, he automatically gains entitlement for Part B on the first day of the month when he completes 65 years of age. If someone’s birthday is on the first day of any month, the entitlement of benefit on the Part B will commence on the first day of the prior month.
If a disabled beneficiary who is below 65 years of age, his/ her entitlement of Part B will start when he/she has completed receiving disability benefits from Social security or Railroad Retirement Board for a period of minimum 24 months. A patient of Lou Gehrig’s disease or ALS (Amyotrophic Lateral Sclerosis) receives benefits under Part B immediately after his/ her disability benefit begins.
However, for entitlement of Part B every individual must be a lawful U.S citizen with permanent residence and has resided continuously in the United States during the 5 years immediately preceding the month of enrollment.
When one gets Part B automatically under the following circumstances:
- The individual is in receipts of benefits from Social Security or the Railroad Retirement Board (RRB)
- Is below 65 years of age and have a disability
- Or, a patient of Lou Gehrig’s disease (also called ALS or Amyotrophic Lateral Sclerosis)
- Lives in Puerto Rico and get benefits from Social Security or the Railroad Retirement Board
A person who is automatically enrolled receives red, white, and blue Medicare card in the mail three months before his 65th birthday or 25th month of disability.
When one has to sign up to get Part B:
- One who is still working and are not receiving any benefits from Social Security or Railroad Retirement Board
- One who has qualified for End-Stage Renal Disease (ESRD)
- One who lives in Puerto Rico and wants to sign up for Part B
Applying for Medicare Part B involves the following steps:
- Verify your eligibility with regards to age and citizenship status
- Contact your local Social Security office for enrollment in Medicare Part B
- Submit relevant information like date of birth, citizenship and marital status and annual income to your Social Security administrator
- Ask the administrator about the monthly premium amount
- Determine your preferred mode of payment acceptable to them
What is Medicare Part B
Medicare Part B provides coverage for medically-necessary medical services and supplies. This includes, but is not limited to, outpatient care, doctors’ services, and home health services. Together with Medicare Part A, Part B is known as Original Medicare. Further, it covers many preventive care and diagnosis services.
Additional services covered by Medicare Part B include:
- Doctor services received at a hospital, doctor’s office, or other health care facility
- Medically necessary services or supplies that are needed for the diagnosis or treatment of your medical condition and meet accepted standards of medical practice. (For example, laboratory tests, X-rays, physical therapy or rehabilitation services, etc.)
- Ambulance services
- Some home health care
- Preventative services to prevent illness or detect them at an early stage for best result.
Use this calculator to get an estimate of when you’re eligible for Medicare and your premium amount.