What is Medicare and How Does it Work

Medicare is a public health insurance program that helps people aged 65 years and older and confident younger persons with permanent disabilities. The Centers for Medicaid and Medicare Services administers the program in the United States. It usually provides health care coverage to more than 54 million Americans or about one in four Americans. It provides health benefits to a specific individual. The United States administers the program as a government and is funded by both the government and contributions from beneficiaries themselves. Medicare coverage for Part A, Hospital Insurance benefits includes inpatient hospital care, skilled nursing facility care after a hospital stay, home health services, part-time care in a nursing home if recommended by your doctor, and hospice care. It also covers certain home health services, durable medical equipment, and prescription drugs. Part B, Medical Insurance benefits, covers things like doctors’ services, outpatient hospital care, medical equipment and supplies needed in a doctor’s office or a clinic, physical therapy services after a hospital stay, and most of the cost of these prescription drugs. Part D is optional coverage for prescription drugs.

Who is eligible?

Anyone eligible for Social Security Disability Income, who is above the minimum age boundary of 65 years, and have a minimum life expectancy of at least 20 years after their first Medicare Part A or Part B benefits payment. Individuals suffering End-Stage Renal Disease are also eligible for it.

What is covered and how?

Many Medicare beneficiaries can now receive prescription drugs, such as Adderall. They are covered by Part D.
Medicare covers services or supplies that are reasonable and necessary in a doctor’s office or facility. The doctor must show that the service or supply is reasonable and necessary for your medical or personal care. It also covers a few preventive and educational services if your doctor recommends them.

How do you apply?

You can apply for Medicare either when you are first eligible or at any time during the year. If you enroll during the year, your coverage begins the first day of the month your application is received. You will have a 60-daytime frame to apply after you are eligible. If you don’t enroll during your initial eligibility period, you can enroll later in the year. You will have a 7-month grace period to apply. If you miss that deadline, you must wait until the next general enrollment period to apply. This general enrollment period is from January 1 through March 31.

Medicare application fee

Every applicant for Original Medicare must pay a one-time fee when applying for Part A, mainly based on Hospital Insurance, or Part B, which is based on Medical Insurance. These initial Medicare application fees, which the applicant usually pays, are not refundable. The Social Security Administration determines the Medicare application fee.

To be eligible to receive Medicare benefits, you must have worked or have been deemed eligible to receive Social Security disability benefits and paid Medicare taxes. There is no application fee for people who are 65 or older, people with permanent disabilities who apply within two years of the onset of their disability and need long-term care, or people who have Breast or Cervical Cancer.

Some people eligible for Medicare benefits may get some of their Medicare premiums paid by the government. The most common of these are people with a low income. Suppose you are determined eligible for Medicare only because you have a low income. In that case, your Part B premiums are not due until you have paid enough in Social Security taxes to cover the cost of your Part B coverage. You will receive a bill for the difference between the Part B premiums you have paid and what everyone else pays, plus any Part D premiums if applicable for the month. If you have coverage under both Medicare and Medicaid, your Part B premium will still be covered by Medicaid.
If your financial situation changes for the next year, you will have to pay premiums based on your income, but you may be able to get some or all of your Part B premiums paid again. It is called redetermining eligibility.

Conclusion

Medicare benefits do not cover everything. Medicare will not help pay for things that are considered to be cosmetic or experimental. Medicare does not cover these items.

Medicare benefits do not pay for all services prescribed by a doctor, even if you are in the hospital or in a facility that accepts Medicare patients. Medicare will not include costumes; custodial care; hearing aids or other medical devices that can be worn on the body, such as crutches, canes, and wheelchairs; and cosmetic surgery if it is intended to improve a person’s appearance.

Medicare does not always cater for the cost of prescription drugs, except for medicines used to control diabetes. A doctor must prescribe the drugs, and the prescription must be filled by a community pharmacy licensed to accept Medicare assignments.

Medicare does not cover the cost of routine eye exams or eyeglasses prescribed by your doctor(s). An individual may have to pay an annual deductible before Medicare pays for any services.