Medicare: A Beginner’s Guide to Senior Healthcare

Green Settlements Staff

Medicare, the national health insurance program for seniors over the age of 65, is a sweeping program that provides benefits for over 61 million recipients each year. Most people have heard the word, but few understand the nuances of the program. After all, each of the four parts provides a different level of coverage, so there are a lot of distinct details to digest.

If you’ve got questions, we’ve got you covered. Here are the basics every senior should know about their Medicare options.

Do I Qualify?

Generally, Medicare is available to seniors over the age of 65, as well as younger people with disabilities. If you receive Social Security benefits, which you become eligible for at age 62, you will automatically qualify for Medicare when you reach 65.

What Does Medicare Cover?

Medicare is offered in four parts, and each tier provides a different type of coverage:

  • Part A: All enrollees receive Part A, which covers inpatient hospital care, surgeries, skilled nursing care, and more. As long as you’ve worked at least 10 years and paid Medicare taxes during those years, you’re eligible to receive premium-free coverage.
  • Part B: Doctor visits and tests are covered under Part B, as well as outpatient care and medical equipment. You’ll be required to enroll in Part B if you aren’t already getting “creditable coverage” elsewhere, like from an employer or spouse.
  • Part C: Otherwise known as Medicare Advantage, Part C is available as an alternative to traditional Medicare and includes services covered under Parts A and B, as well as prescription drugs (Part D).
  • Part D: Like Medicare Advantage, Part D, which covers prescription drugs, is provided through private insurance companies. Unless you receive drug coverage from another source (like Advantage), you will be required to purchase Part D.

Can I Get Assistance If I Can’t Afford My Premiums?

With all the different layers of coverage, you may be concerned about whether you can afford Medicare. Beneficiaries with limited income can take advantage of a Medicare Savings Program (MSP), which can be used to pay premiums, deductibles, and coinsurance. There are four types of savings programs and they all come with their own income limits and requirements.

Do All Healthcare Providers Accept Medicare?

Most doctors (96 percent) accept traditional Medicare. Some medical practices, however, prefer to treat patients insured with certain Medicare Advantage plans, because they often provide higher reimbursement rates.

All of these plans, each with their own set of rules and conditions, may seem overwhelming. The good news is you have a range of options available to you when it comes time to enroll in Medicare. Make the most of your benefits by doing your research before determining which plan is right for you.

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