By: Mei Kameda, Program Coordinator, Keiro
Medicare is a federal health insurance program for people who are 65 years or older, certain younger populations with disabilities, and people with certain medical conditions such as End-Stage Renal Disease (ESRD).
Every year, Medicare has an Open Enrollment period, October 15th – December 7th. What’s very important about Open Enrollment is that during this period of time, Medicare health and drug plans make changes in terms of cost, coverage, and what providers and pharmacies are in their “network”. This time allows people with Medicare to change their Medicare health plans and prescription drug coverage for the following year to plans that better suit their needs. You are not required to change your plan during this period.
Today’s blog post will include a general overview of eligibility criteria and the different parts of Medicare.
Medicare is a special insurance program for qualified individuals. These qualifications include:
If you are 65 years old or older:
- You are a U.S. citizen or a permanent legal resident who has lived in the United States for at least 5 years.
- You or your spouse has worked enough to receive Social Security or railroad retirement benefits (typically about 10 years of work)
- You or your spouse is a government employee or retiree who has not paid into Social Security but has paid Medicare payroll taxes while working.
If you are UNDER 65 years old:
- You have been entitled to Social Security disability benefits for at least 24 months (do not need to be consecutive); or
- You receive a disability pension from the Railroad Retirement Board and meet certain conditions; or
- You have Lou Gehrig’s disease (ALS – amyotrophic lateral sclerosis), which qualifies you immediately; or
- You have an ESRD (End-State Renal Disease) which requires dialysis or a kidney transplant and you or your spouse has paid Social Security taxes for a certain length of time (depending on your age).
To see your eligibility calculation, please click here.
Medicare has four components:
Parts A & B – also known as the “Original Medicare”
Part C – Medicare Advantage Plan
Part D – Prescription Drug Coverage
Part A – Hospital Insurance
Most people DO NOT pay for the Part A premium because they or their spouse already paid for it through their payroll taxes while working. Medicare Part A covers inpatient care in hospitals (including critical access hospitals), skilled nursing facilities (not including custodial or long-term care), hospice care, and home health care.
Part B – Medical Insurance
Most people will pay a monthly premium for Part B, which helps cover doctor’s services and outpatient care, medical services that Part A does not cover such as physical/occupational therapy, some home health care, and supplies that are medically necessary such as medical equipments including wheelchairs, beds, and walkers. Part B also covers many preventive services including: mammograms (October is Breast Cancer Awareness Month!), cardiovascular disease screenings, diabetes screening, flu shots, and more. Laboratory services are also covered including certain blood tests and urinalysis.
Medicare Part C – Medicare Advantage
This is the part of a Medicare policy that allows private health insurance companies to provide Medicare benefits. The Medicare private health plans, which include HMOs and PPOs, are known as Medicare Advantage Plans. You can also choose a plan that includes prescription drug coverage (there are often no additional premiums) or you can choose a plan without prescription drug coverage. Medicare Advantage plans must cover the same services as Medicare Parts A and B; however they do not provide hospice care (which is still covered by Original Medicare). You must have Part A AND Part B to purchase a Medicare Advantage Plan.
Medicare Part D – Prescription Drug Coverage
Medicare Prescription Drug Plans (PDP) add drug coverage to your Original Medicare and some other plans other than the Original Medicare. You can also get the prescription drug coverage through the Medicare Advantage Plan)
Tip: If your Medicare Advantage Plan includes prescription drug coverage and you JOIN a Medicare Prescription Drug Plan (Part D), you will be disenrolled from your Medicare Advantage Plan and re-enrolled in Original Medicare. So know which plan you are currently enrolled in.
Today’s blog post is just an overview of Medicare. I am hoping to give you more detailed updates and explanations on a weekly basis about Medicare to build confidence among both those who have Medicare or will be enrolling soon.
Next week’s blog will include tips and suggestions on HOW to pick the right plan for you. Stay tuned for next week’s Medicare blog post!
Where to find Medicare plan information and comparison tools?
Call 1-800-MEDICARE or go to www.medicare.gov
New to Medicare? Check out the 2016 Medicare & You booklet here!
In partnership with the Council on Aging Orange County, Keiro staff members, Dianne Kujubu Belli and Kanako Fukuyama are certified HICAP (Health Insurance Counseling & Advocacy Program) counselors. They provide free Medicare and related counseling at Anaheim Free Methodist Church, Orange Coast Free Methodist Church, Orange County Buddhist Church, and Wintersburg Presbyterian Church. Please contact Dianne at 213.873.5702 or email@example.com and Kanako at 213.873.5709 or firstname.lastname@example.org for questions or to make an appointment. Counseling is available in both English and Japanese.
About the Author:
Mei Kameda is the Program Coordinator at Keiro. She graduated from California State University, Long Beach with a Bachelor of Science degree in Community Health Science (option in Community Health Education) and a minor in Communication Studies. In her spare time, Mei enjoys going on runs, baking, and volunteering which are a few of the many activities that allow her to live her life on purpose.
The material presented on this site is for informational purposes only and does not necessarily represent the opinions of Keiro, or its contributors. Readers should consult appropriate health, legal, or financial professionals on any matter relating to their health and well-being. Full disclaimer