Saturday, January 23, 2010

The Basics Of Medicare Eligibility And Coverage

By Allison Meade

American citizens and permanent residents aged 65 years and older can avail of federal health insurance coverage under the Medicare program. Aside from the age requirement, Medicare eligibility is also dependent on one having paid money or taxes into the Medicare program for at least ten years. However, people with a disability or permanent kidney failure can receive Medicare benefits even if they are less than 65 years old.

Medicare benefits include hospital insurance, medical insurance, and prescription drug plans. These are usually referred to as Part A, B and D. Recently, Medicare coverage is increased to include another type of insurance plan called Medicare Advantage. This is Part C.

Part A: Hospital Insurance. Medicare can help pay for your inpatient costs at a hospital, clinic or ambulatory surgical centers. It can also assist on payments for home health care, skilled nursing service and hospice, provided that you meet additional criteria. This benefit does not require any premium payments since this is already paid for with the Medicare taxes deducted from your paycheck when you were still working.

Most people pay monthly premiums for Part B, which is optional if one is still working or currently employed. However, once one becomes eligible for Medicare, the premium becomes more expensive the longer one puts off making enrolling for this benefit. It subsidizes outpatient costs and some services and products not covered by Part A.

Part D: Drug Prescription Plans. The Medicare Prescription Drug coverage helps pay for medicine not covered in Part B. Aside from reducing your prescription medicine expenses, it can also be your defense against higher expenses in the future. The plans are approved and regulated by Medicare, but is actually administered by private insurance companies.

Part C: Medicare Advantage Plan. This is basically another method to get your Medicare benefits. It combines Parts A, B and some aspects of Part D. Private insurance groups endorsed by Medicare administer these plans. The policies cover services that are medically essential and can charge non-standard deductibles, co-payments, or co-insurance for these services.

Unfortunately, these benefits are not enough to cover all the medical expenses that you could incur once you become eligible. Also, there is the concern that the number of senior citizens is increasing more rapidly than the working population who are basically the ones funding Medicare. This means that the federal government bearing some of the cost, and if the trend continues, it will not be able to sustain Medicare beyond 2018, or thereabout.

Still, the advantages outweigh the disadvantages. It is important to learn as much as you can about Medicare eligibility rules and coverage. In the end, education is the key to making the most of your benefits.

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