Medicare Basics: Things You Need To Know

Signed into law to provide health and economic security for seniors in 1965, Medicare is an important source of health insurance coverage for 45 million people. Today, about 97% of older American have health insurance through Medicare.

Being covered by health insurance is vital for people of all ages, but it is especially critical for those with disabilities and those with illnesses and chronic conditions associated with aging. This article is designed to provide you with basic information on Medicare – how it works, how it differs from Medicare advantage plans, and who is eligible.

What is Medicare

The Medicare program is a federal health care insurance program for people over the age of 65 and the disabled. Medicare has two parts. Medicare Part A is a Hospital Insurance program, while Medicare Part B is a Supplementary Medical insurance (most people pay monthly for Medicare Supplement).

Deference between Original Medicare and Medicare Advantage Plans

You can get your health-care coverage from Medicare in one of two ways: enroll in regular fee-for-service program through Original Medicare (Parts A and B) or in a Medicare Advantage plan (also known as Medicare Part C) through a health plan sponsored by a private company. To join a Medicare Advantage Plan, you must have Medicare Part A and Part B.

If you are enrolled in one of Medicare Advantage plans (HMO, PPO, PFFS, and SNP), you still have Medicare Parts A and B, but you get your health-care services through a private plan that has a contract with Medicare.  Medicare Advantage Plans coverage can include prescription drug coverage. You pay your usual Part B premium, plus any additional premium that the plan may charge.

Medicare Advantage Plans may have lower deductibles and co-payments than Original Medicare and cover costs & services not covered by original Medicare. That’s why many people choose Medicare Advantage plans which offer affordable health insurance coverage.

Medicare Eligibility Requirements

Eligibility is not based on financial need. Generally, if you are a citizen or permanent resident of the United States and one or more of these describes you, you are eligible for Medicare Parts A and B:

1. You are 65 years or older and eligible to receive Social Security;
2. You are under 65, permanently disabled, and have received Social Security disability insurance payments for at least 2 years;
3. You are under 65 years of age with end-stage renal disease (ESRD) and you or your spouse has met the Medicare work requirement.

If you already get benefits from Social Security or the Railroad Retirement Board, you are automatically entitled to Medicare Part A and Part B starting the first day of the month you turn age 65. You will not need to do anything to enroll.