Originating in the 1960s, Medicare is a government-provided fee-for-service insurance program intended primarily for seniors. The program encompasses several distinct parts, each of which is outlined below.
When do you qualify for Medicare?
If you’re under the age of 65, you may qualify for Medicare if you have a disability, End Stage Renal Disease, permanent kidney failure (ESRD), or Lou Gehrig’s Disease (ALS).
You typically qualify for Medicare when turning 65 and can enroll during your initial enrollment period, which includes the 3 months before your 65th birthday, the month of your birthday, and the 3 months after your birthday.
Medicare Part A
Medicare Part A covers the cost of inpatient semi-private room and board. Typically, there is no monthly cost for Medicare Part A if you have paid FICA taxes for 10 years (equivalent to 40 quarters).
Medicare Part A covers the following:
- Inpatient care: If you are admitted to a hospital, you have the Part A deductible, and Medicare covers the cost for the first 60 days. For days 61-90, you have a daily copay, and beyond 90 days, a separate daily copay applies. For skilled nursing care, you are covered for the first 20 days. For days 21-100, you have a daily copay.
To qualify, under Medicare rules, you must spend 3 days consecutively in a hospital due to a health condition that requires skilled nursing care. In addition, the coverage is limited to 100 days per benefit period.
- Hospice care: Medicare Part A covers the cost of Hospice care for terminally ill individuals, but requires a medical professional to certify the need for this type of care.
Medicare Part A Benefit Period
The benefit period for Part A is the time between when you are released from a hospital or skilled nursing facility (SNF) and you haven’t received any inpatient care for 60 consecutive days or more. If you are admitted again, you begin a new benefit period.
Medicare Part B
Medicare Part B has a monthly premium and annual deductible. Once your deductible is met, Medicare covers 80% and you pay 20% of the approved care amount.
Medicare Part B covers a wide variety of standard outpatient medical services including but not limited to:
- Doctor visits
- Specialist
- Health screenings
- Ambulance services
- Lab tests and services
- X-rays
- Durable and portable medical equipment
- Diabetes and other screenings
However, Medicare Part B does not cover routine physical exams, prescription drug costs, dental care, vision care, hearing aids, or alternative medical services such as acupuncture.
There are additional guidelines and specific timeframes to consider regarding Medicare Part B premium and late enrollment penalties. If you have any questions, please contact Cole Insurance and Senior Solutions, and we’ll be happy to assist you.