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Medicare 101: The Basics and Other Things You Should Know

In the 2018 calendar year, 59,989,883 million United States (U.S.) citizens enrolled in the Medicare program.

MDCR ENROLL AB 1

That’s close to 60 million people around the U.S. who have been enrolled in Medicare and are using the Medicare program to pay for their healthcare services.

But what is Medicare exactly?

How do you enroll in the Medicare program?

How do I know if I’m eligible for Medicare?

Read more to discover the basics of the Medicare program including what it is, how to determine eligibility, and what it covers.

How Do You Become Eligible for Medicare?

In order to become eligible for Medicare, the following has to apply to you:

  • You’re at least 65-years-of-age or older.
  • You’re under the age of 65 and have a disability in which you’re receiving Social Security Disability Insurance, for a particular period of time.
  • You suffer from End-Stage Renal Disease (permanent kidney failure that requires dialysis or a kidney transplant).

https://www.medicare.gov/what-medicare-covers/your-medicare-coverage-choices/whats-medicare

How is Medicare Funded?

Medicare is a Federal Government-funded health insurance program, administered and managed by the Centers for Medicare & Medicaid Services (CMS).

The Medicare program is funded partly by ​ Social Security​ and the following:

  • Medicare taxes that are imposed on your income (automatically deducted from your paycheck).
  • From Medicare premiums that are paid from people who are enrolled in the Medicare program.
  • The Federal budget.

https://www.medicareinteractive.org/get-answers/medicare-basics/medicare-overview/introduction-to-medicare

How to Enroll in the Medicare Program

In order to enroll in the Medicare program, you have to sign up through Social Security. If you’re over the age of 65 and haven’t been receiving benefits from Social Security, then you must sign up in order to enroll in the Medicare Part A and Part B benefit; it won’t happen for you automatically.

Once you sign up, you’ll be automatically enrolled in Medicare Part A.

If you’re receiving benefits from the Railroad Retirement Board, you’ll receive the Medicare Part A and Part B benefit automatically when you’re first eligible.

Get started with Medicare

Then you choose your Medicare coverage:

  • Original Medicare​ – Comprising of Medicare Part A and Part B.
  • Medicare Advantage​ – An alternative to Original Medicare that can include Medicare Part D.

Enrollment Periods

When first becoming eligible for Medicare, there’s a seven-month Initial Enrollment Period
where you’re able to sign up for Medicare Part A and Part B.

Part A & Part B sign up periods

Once you become eligible for Medicare at the age of 65, you’re now able to sign up during that seven-month Initial Enrollment Period due to the following circumstances:

  • Starting three-months prior to the exact month you turn 65-years-old.
  • The exact month you turn 65-years-old.
  • Ending three-months after the month you turn 65-years old.

You can enroll in Medicare Part A and Part B during the General Enrollment Period as well.

The General Enrollment Period is between January 1 through March 31 of each year. You’d only be eligible to enroll during the General Enrollment Period if you either didn’t sign up for Medicare when you were first eligible, during the Initial Enrollment Period, or you’re not eligible to enroll during Medicare’s Special Enrollment Period.

Note: There is a chance you may have to pay higher premiums due to your late enrollment in Medicare Part A or Part B. It’s better to sign up and enroll as soon as you’re eligible to do so.

After your Initial Enrollment Period ends, you have an opportunity to enroll in Medicare during a Special Enrollment Period.

If you haven’t retired yet and are still working, therefore you’re still being covered under a group health insurance plan via your employer, you’re eligible to enroll in Medicare Part A and Part B at any time; as long as the following applies:

  • Either you, your spouse (if you’re married), or a family member (if you happen to be disabled), is still employed and working.
  • You’re covered under a group health insurance plan through your employer.

There’s also an eight-month Special Enrollment Period in which you’re eligible to enroll in Medicare Part A & Part B if one of these situations occur (whatever situation happens first):

  • After you finish working and are no longer employed with that employer – the month after your employment ends.
  • The month after the group health insurance plan ends, based on your employment ending.

What Does Medicare Cover?

Medicare is comprised of a variety of parts.

Those parts are as follows:

https://www.medicare.gov/what-medicare-covers/your-medicare-coverage-choices/whats-medicare

Medicare Part A (Hospital Insurance) Benefit – This benefit covers:

  • Inpatient hospital care
  • Services and care while in a skilled nursing facility (SNF) (not custodial or long-term)
  • Hospice care
  • Home health care
  • Nursing home care (inpatient care while in a SNF)

In general, you don’t have to pay a premium for the Medicare Part A benefit as you’ve already paid into the system by means of the Medicare tax deductions from your paychecks through the years.

Medicare Part B (Medical Insurance)​ ​ Benefit This benefit covers:

  • Specific doctors’ services
  • Preventive services

Medicare Part B also covers services, such as clinical research, ambulance services, durable medical equipment, mental health services, inpatient and outpatient care, partial hospitalization stays, and qualified outpatient prescription drugs.

What Part B covers

Medicare Part D (Prescription Drug) Benefit​ This benefit tacks on prescription drug coverage for the following plans:

  • Original Medicare
  • Certain Medicare Cost Plans
  • A number of Medicare Private-Fee-for-Service Plans
  • Medicare Medical Savings Account Plans

Medicare Part D plans are purchased through private insurance plans.

What Doesn’t Medicare Cover?

There are certain instances and procedures that Medicare Parts A & B won’t cover.

Medicare doesn’t cover the following:

  • Long-term care​ (or custodial care)
  • Some dental treatments
  • Eye exams, in relation to eyeglasses and eyeglass prescriptions
  • Dentures
  • Cosmetic surgeries
  • Acupuncture services
  • Hearing aids and hearing aid fitting exams
  • Standard (routine) foot care

What’s not covered by Part A & Part B?

Why Doesn’t Medicare Cover Long-Term Care?

Medicare doesn’t cover long-term care because a majority of nursing home care is considered custodial care 9 . Most long-term care services don’t consist of actual medical care being administered. Rather, a portion of some long-term care services includes assistance with basic, everyday, menial tasks, such as washing yourself, getting dressed, and using the bathroom.

Long Term Care Coverage

Still Confused About Your Medicare Options?

Have additional questions regarding Medicare, Medicare enrollment, and Medicare eligibility? Visit Medicare.gov for more information.

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