As our parents age, things like health insurance become vitally important. Even if you don’t know very much about Medicare, I’m here to give you everything you need to know so you can help your parents see if they are eligible.
Medicare represents a cost-effective option for obtaining medical care for seniors or younger people with qualifying medical conditions. However, there are a number of factors to consider in determining who is eligible for Medicare. There are also a number of options for Medicare coverage.
The bottom line is that there is no single Medicare option that is right for everyone. The right coverage depends on a number of factors, including the age and health of the individual.
There are several criteria that determine who is eligible for Medicare. Generally, individuals who are age 65 or older, are eligible for Social Security benefits and are either American citizens or have held legal permanent resident status for at least five years are also eligible for traditional Medicare, also known as Part A (hospital insurance) and Part B (medical insurance).
Younger people who are permanently disabled and receiving benefits from Social Security or the Railroad Retirement Board are also eligible for traditional Medicare. Individuals of any age who are suffering from end-stage renal disease (ESRD) or Amyotrophic Lateral Sclerosis, commonly known as Lou Gehrig’s disease, are also eligible for traditional Medicare.
There is generally no premium for Part A. However, the premium for Part B for 2020 is at least $144.60 per month, with higher premiums required from recipients who have higher incomes. In addition, deductibles and co-pays apply to traditional Medicare.
Part D Prescription Coverage
Traditional Medicare does not cover the cost of prescription medications. However, individuals who have enrolled in Part A and Part B Medicare are eligible to add Part D, which covers prescription drug costs. Part D plans are administered by private insurance companies that have been approved by Medicare, and carry separate premiums.
Medicare Advantage Plans
Medicare Advantage plans combine Parts A and B of traditional Medicare coverage, and are often referred to as Part C Medicare, which is administered by private insurance companies that have been approved by Medicare. Individuals who have enrolled for Medicare coverage are eligible to substitute Part C for traditional Medicare.
In addition to combining Parts A and B, Medicare Advantage plans often include prescription drug coverage. Medicare Advantage plans also frequently include extra benefits, such as vision, hearing, and dental care, as well as home modifications such as wheelchair ramps that facilitate aging in place. However, individuals enrolled in Part C are not eligible for Part D or Supplemental Insurance coverage.
Supplemental insurance plans are designed to cover out-of-pocket costs associated with Medicare, such as deductibles and co-pays. These plans are also known as “Medigap” insurance plans. Plans are administered by private insurance companies, but standardized by the federal government, so it is relatively easy to compare and contrast different plans.
If Medigap insurance coverage is added when an individual first enrolls in Medicare Parts A and B, acceptance is guaranteed, and renewal is guaranteed as long as individuals pay the premium. However, individuals who attempt to add Medigap coverage after the initial enrollment period may be declined coverage, especially if they have a preexisting medical condition.
Open Enrollment and Disenrollment
The open enrollment period for Medicare runs from October 15 through December 7 each year. During that time, individuals may enroll in Part C or traditional Medicare, or switch between the two. Open Enrollment is also the period for adding Part D or applying for Medigap insurance coverage to traditional Medicare.
However, individuals who have enrolled in Part C are eligible for disenrollment between January 1 and March 31. During this time, they may change their Part C plan or transition from Part C to traditional Medicare. However, individuals who are enrolled in traditional Medicare are not eligible for disenrollment.
Choosing the Right Medicare Coverage
Individuals who are eligible for Medicare have several options, including traditional Medicare with or without Part D or Medigap coverage or Medicare Advantage plans. There is no single solution that is right for everyone. A number of factors, including age, budget and underlying medical conditions determine which Medicare choice is the right one.