Medicare is a federally mandated health insurance coverage that is available to people 65 years and older, as well as to young people who are disabled or have irreversible kidney failure or Lou Gehrig's disease. It provides healthcare coverage to all of its beneficiaries, regardless of their income, medical history, or present state of health.
The Medicare and Medicaid programs were established in 1965 by President Lyndon B. Johnson. Over the years, the Medicare program has grown to include prescription medication coverage as a part of its benefits. Approximately 62 million people receive Medicare coverage through the Centers for Medicare & Medicaid Services (CMS). By 2030, enrollment is expected to exceed 80 million as the youngest boomers reach retirement age.
As part of its comprehensive medical coverage, Medicare provides seniors and those with disabilities with a broad range of preventative, regular, and emergency medical treatments, including assisted living and long-term care.
In contrast to the over 50% uninsured rate reported in the early 1960s, the number of adults 65 and older who are uninsured has fallen to less than 1%.
Take Care Of Your Health
Medicare eligibility is determined by the Social Security Administration, and it can be attained through three avenues:
- Getting to 65 years old
- Qualifying for disability
- Dealing with permanent kidney failure (end-stage renal disease) or amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease)
Medicare applications can be submitted by individuals eligible based on their age three months before they reach 65. However, those under 65 who receive Social Security Disability Insurance (SSDI) generally have to wait for two years before becoming eligible for Medicare. On the other hand, those receiving SSDI due to permanent kidney failure or ALS can access Medicare immediately without any waiting period.
There are several options for obtaining Medicare coverage, such as retiring and having Medicare as your primary coverage or staying in the workforce and making Medicare your secondary payer.
What Is Medicare Structure?
Medicare is organized into distinct parts, each addressing specific healthcare needs. Part A primarily covers hospital expenses, while Part B is focused on outpatient and office-based care. When Parts A and B are joined together, they form what is known as original Medicare.
Medicare Part C, often referred to as Medicare Advantage (MA), provides an optional alternative. MA presents an alternative method of receiving benefits by consolidating the individual components of Medicare.
Part D is structured for prescription drug coverage and is also discretionary. It's crucial to exercise caution to avoid incurring a late enrollment penalty if you lack other drug coverage when enrolling in Medicare.
With the different Medicare segments, you may end up paying two or three Medicare premiums each month. Typically, premiums for Parts B and D are withheld from your Social Security benefits.
Additionally, you might incur a separate premium for a supplemental insurance policy (Medigap). Medigap helps cover out-of-pocket expenses that can accumulate, including deductibles and copays for Parts A and B. In certain situations, Medigap plans may also provide coverage for emergency healthcare during international travel.
Achieving well-being and happiness might not be as easy as making a purchase, but enrolling in health insurance can create a positive impact. Studies show that individuals who are covered tend to experience improved health outcomes, reduced personal medical costs, and a diminished risk of facing financial challenges.
- Financial Protection: Medicare provides essential protection for individuals without straining their finances, helping them manage increasing healthcare expenses.
- Assurance in Pandemic Times: The recent COVID-19 pandemic highlighted the value of steadfast health coverage, exemplified by Medicare, in ensuring individuals receive appropriate care during health emergencies like pandemics.
- Legal Mandate: Medicare is a legal obligation across the United States, ensuring that every adult and their dependents have access to coverage. The primary goal of this mandate is to increase the number of insured individuals and lower the average insurance premiums.'
- Penalty Abatement: Having Medicare or equivalent health insurance coverage helps individuals in avoiding tax penalties for being uninsured, ensuring their compliance with legal mandates and the maintenance of their financial security.