Medicare benefits play an important role in the lives of millions of seniors and some disabled people under the age of 65. The Medicare program got its start in 1965, and since that time, it has gone on to become vital in ensuring the healthcare and financial well-being of seniors across the country.
Medicare is health insurance that is government-sponsored, but it is partially paid through payroll deductions that are made during your working years along with monthly premiums for some parts of the program. Once you’re eligible for Medicare, you may be responsible for cost-sharing for services and supplies.
What Does Medicare Cover?
Medicare benefits are provided through several different parts of the program. Each part is designed to cover a specific type of medical care, and you can choose which parts are right for you.
Medicare Part A is the inpatient portion of Original Medicare, and it covers things like inpatient hospital admission and admittance to skilled nursing facilities. In order for admittance to qualify for Medicare benefits, the facility to which you are admitted needs to be approved by Medicare.
Medicare Part B is the outpatient portion of Medicare, and it covers things like visits to your doctor’s office, outpatient surgical procedures and diagnostic testing. Additionally, Medicare Part B covers durable medical equipment (DME), including items like wheelchairs and some monitoring equipment to be used at home. While many people opt for Part B coverage, it is optional.
Medicare Part D is the prescription drug benefit of Medicare. It covers prescriptions that can be purchased from retail pharmacies for self-administration. It does not cover injection or infusion drugs that are administered in a clinical or inpatient setting. Medicare Part D is optional coverage, so it is not required in order to take part in any other Medicare benefit.
What Do I Need to Know About Medicare Eligibility?
Medicare eligibility generally begins at age 65. There are some situations, however, in which you can qualify for Medicare under the age of 65. These include instances where you receive Social Security Disability Insurance (SSDI). You must receive SSDI or Railroad Retirement Board benefits for at least 24 months consistently before you are able to apply for Medicare under the age of 65.
Barring disability, you can apply for Medicare benefits during a seven-month Initial Enrollment Period that occurs during the year of your 65th birthday. This period is made up of the three months preceding your birthday month, your birthday month itself and the three months that follow the month you turn 65. Failing to enroll during this time frame may incur penalties for late enrollment.
You can also make changes to your plan during the Open Enrollment Period that occurs each year between October 15th and December 7th. During this time, you can change your plan without penalty, or you can add or remove parts of Medicare. Medicare eligibility regulations also allow for changes to be made during Special Enrollment Periods that are triggered by certain life events.
Do I Need to Be Retired to Qualify for Medicare?
Although Medicare is often used by retired seniors, you do not have to be retired in order to be eligible to receive Medicare. Medicare eligibility is based on your age, so even if your peers have decided to stop working, this doesn’t mean that you have to when you reach age 65. You may continue to work while receiving Medicare benefits.
Dual-Eligibility for Medicare and Medicaid
You may also be eligible to receive both Medicare and Medicaid. This classification is known as dual-eligible. In order to receive benefits from both programs, you will need to meet the eligibility requirements of Medicare, meaning you will need to be at least 65 or receive SSDI, but you will also need to fall below the income threshold for Medicaid set by your state.