Medicare- Benefits and Eligibility



Medicare is a one of major insurance in USA Healthcare segment. In the United States of America, Medicare is a single-payer national social insurance health program administered by the American Federal Govt. since 1966. Medicare is administered by Center for Medicare and Medicaid Services(Formerly known as Healthcare Financing Administration-HCFA) of the U.S. Department of health and human services. Medicare and Medicaid are the two government-sponsored medical insurance schemes in the USA. Medicare is further divided into parts 1-A and 2-B – Medicare Part A covers hospital and hospice services and  Part B covers outpatient services. Part D covers self-administered prescription drugs. Part C is alternative to the other parts intended to allow with differently structured plans in an effort to reduce costs to government and allow patients to choose plans with more benefits.

Eligibility for Medicare:

  • People 65 years of age or older is eligible for Medicare.- Those who are 65 and older who choose to enroll in Part A Medicare must pay a monthly premium to remain enrolled in Medicare Part A if they or their spouse have not paid the qualifying Medicare payroll taxes.
  • If a person is below 65 yrs but have some disabilities is eligible for Medicare Services.- who receive SSDI are eligible for Medicare while they continue to receive SSDI payments; they lose eligibility for Medicare based on disability if they stop receiving SSDI. The 24-month exclusion means that people who become disabled must wait two years before receiving government medical insurance unless they have one of the listed diseases. The 24-month period is measured from the date that an individual is determined to be eligible for SSDI payments, not necessarily when the first payment is actually received. Many new SSDI recipients receive “back” disability pay, covering a period that usually begins six months from the start of disability and ending with the first monthly SSDI payment.
  • People with End Stage Renal Disease (ESRD)– Permanent kidney failure requiring dialysis or a transplant.

Medicare Plans-

Medicare has mainly 2 plans part A and part B. Other plans are Part C and Part D.

Part A- Part A covers inpatient hospital stays, including semi-private room, food, and tests. The maximum length of stay that Medicare Part A covers in a hospital inpatient stay or series of stays is typically 90 days. The first 60 days would be paid by Medicare in full, except one copay (also and more commonly referred to as a “deductible”) at the beginning of the 60 days.

 Part B- Part B is optional and is offered to all beneficiaries when they become entitled to Part A. It may also be purchased by most persons age 65 or over who do not qualify for premium-free Part A coverage. While most of the people do not have to pay a premium for Part A, everyone must pay for Part B if they want it.

Part C- Medicare Part C are Medicare advantage plans also known as “MA Plans”. These plans are offered by private health insurance companies approved by Medicare. Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan and not Original Medicare.

Part D- Medicare part D is also known as Prescription and drug plan.Medicare Part D went into effect on January 1, 2006. Anyone with Part A or B is eligible for Part D, which covers mostly self-administered drugs. It was made possible by the passage of the Medicare Modernization Act of 2003. To receive this benefit, a person with Medicare must enroll in a stand-alone Prescription Drug Plan (PDP) or Medicare Advantage plan with integrated prescription drug coverage (MA-PD). These plans are approved and regulated by the Medicare program, but are actually designed and administered by private health insurance companies and pharmacy benefit managers.

Some Medicare information and guidance books are available at Amazon, for see please click on below  links-

1-Get What’s Yours for Medicare: Maximize Your Coverage, Minimize Your Costs (The Get What’s Yours Series)

2-Medicare For Dummies (For Dummies (Business & Personal Finance))

Happy Learning..!

Best Wishes…


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