Medicare is a federal health insurance program for individuals age 65 or older or individuals with a disability. To qualify for Medicare, an individual or his spouse must have worked and paid Medicare taxes for at least 10 years. An individual is also eligible if a deceased spouse or ex-spouse worked and paid Medicare taxes for 10 years.
There are two ways an individual can have coverage: 1) Original Medicare, consisting of Parts A, B, & D; or, 2) Part C, also referred to as Medicare Advantage.
Part A is referred to as hospital coverage. It covers inpatient hospital stays, skilled nursing care, some home health, and hospice. There is no premium for Part A, unless an individual has not met the work requirement. An individual can sign up for “premium free” Part A once eligible. She can also apply late without a penalty. Part A coverage is subject to deductibles and co-pays.
Part B is referred to as medical insurance coverage. It covers preventative care, doctors visits, medical supplies, and outpatient services. The standard monthly premium for Part B is $121.80 in 2016. This premium increases each year. Individuals with higher income pay a higher premium. Individuals who enroll in Part B late will pay a penalty for late enrollment. Part B coverage is also subject to deductibles and co-pays.
Part D is referred to as prescription drug coverage. It covers prescription drug costs. Part D plans are offered by various insurance companies. Each plan has a premium, deductible, and co-pays for drugs. There may be a penalty for late enrollment. To determine which plan is best for you, visit the Find a Plan page.
Part C is known as Medicare Advantage. Part C is offered by a private company, often a managed care organization. It offers the benefits of Parts A and B. Most Advantage plans offer prescription drug programs. These plans may also offer additional coverage including dental care, vision care, and even gym memberships. There may be an additional premium associated with Advantage plans. Providers may be limited to those in a plan’s network.
For more information or to enroll online, Medicare.gov.
