Are you or a loved one nearing the Medicare age but are unsure what this benefit provides or the plan that is best for you? Medicare is the national insurance program for adults age 65 and older. It’s also a benefit most working adults pay for throughout their lifetime.
Throughout the years, Medicare has evolved and extended the amount of plans available. Understand your options now, so you can pick the best plan for you or your loved one when the time comes.
What is Medicare?
The concept of federally funded health insurance dates back to the days of President Harry Truman, who pushed for a national health insurance plan for all qualifying Americans. His push failed, and it would take another two decades for Congress to adopt a national healthcare insurance plan. This one would be solely for older adults, setting the Medicare eligibility age at 65. The first American seniors began receiving Medicare in 1965.
Initially, Medicare started under the Social Security Administration, but the program is now run by the Centers for Medicare/Medicaid Services and is funded primarily through tax dollars in the form of a payroll deduction.
When Medicare first began, it was exclusively for those 65 and older and only included parts A and B. Over time, the program was extended to individuals under the age of 65 with certain disabilities and anyone with end-stage renal disease. Supplemental plans were also added for Americans to choose from. According to CMS, more than 62 million Americans received health insurance through Medicare in 2020.
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What is the Difference in Medicare and Medicaid?
While Medicare was designed primarily for older U.S. adults, Medicaid is not age specific. Instead, it is designed for those needing financial assistance with their healthcare. Both are government programs overseen by CMS but unlike Medicare, Medicaid coverage is dictated by each state, following federal guidelines. Though it does vary, coverage and eligibility are usually dictated by your income and liquid assets.
Depending on your plan, you may have to pay some deductibles and other costs under Medicare. With Medicaid, you typically don’t have to pay anything for covered healthcare expenses. Some of the covered benefits under Medicaid include inpatient and outpatient hospital services, physician services, laboratory and X-ray services and home health services.
If you are on Medicaid when you turn 65, you may be eligible to receive coverage from both Medicare and Medicaid. This is called dual eligibility. Call your State Medical Assistance (Medicaid) office for more information to see if you qualify.
What is the Medicare Age, and How Do I Enroll?
You are automatically signed up for Medicare at age 65. However, if you want to select a Medicare health or drug plan, you have a seven-month period around your 65th birthday to sign up for one. This is called the initial enrollment period, and it:
- Starts three months before you turn 65; if a plan is selected during this period, it will go into effect the first day of the month you turn 65.
- Includes the month you turn 65; if a plan is selected during this period, it will go into effect the first day of the month following your 65th birthday.
- Ends three months after you turn 65; if a plan is selected during this period, it will go into effect the first day of the month after you enroll.
If you later decide to change your plan or join a plan after that seven-month period has closed, enrollment is open each year from Oct. 15 to Dec. 7. Changes or enrollment during this time period will go into effect the following January.
What are the Different Plans?
In general, there are two types of Medicare plans: traditional Medicare and Medicare Advantage.
Traditional Medicare includes Parts A and B. Part A is automatic and includes hospital insurance, which covers hospital stays, as well as skilled nursing facilities and hospice. Part B is optional and is deducted from your Social Security should you enroll. It includes medical insurance, which covers outpatient services, as well as some physician visits and preventative care. Other supplemental plans can be added through private insurance companies; these are paid for out-of-pocket.
Also referred to as Medicare Part C or MA plans, Medicare Advantage is an all-inclusive plan that includes both parts A and B, as well other coverage such as prescription drugs, dental and more, depending on the plan. These plans are offered through private Medicare-approved companies. If you join a Medicare Advantage plan, you will likely be required to choose healthcare providers that participate in your plan’s network.
What to Consider When Picking a Medicare Plan
When it comes to deciding between a traditional Medicare plan and a Medicare Advantage plan, consider two things: your income and your freedom to choose your provider. As you add supplemental plans to traditional Medicare, it can cost more than Medicare Advantage plans. However, with traditional plans, you have the freedom to choose any Medicare-approved, certified provider anywhere. Most Medicare Advantage plans require you to see a provider within their network and may require prior approval or a referral for certain procedures or healthcare services
If you’re still searching for answers on what the best plan is for you, Medicare offers these seven things to consider when selecting your Medicare coverage.
There are a variety of Medicare plans out there today, so as you near the Medicare age of 65, start researching your options to find the one that best meets your needs.