Medicare is a federal health insurance program in the United States primarily for people aged 65 or older. It also provides coverage for certain younger individuals with specific disabilities, End-Stage Renal Disease (ESRD - permanent kidney failure requiring dialysis or a kidney transplant), or Amyotrophic Lateral Sclerosis (ALS, also known as Lou Gehrig's disease).
The program helps with the cost of healthcare but does not cover all medical expenses or most long-term care. Medicare is divided into different parts, each covering various services:
Generally, you are eligible for Medicare if you are:
Age 65 or older: Most people qualify if they are U.S. citizens or legal residents who have lived in the U.S. for at least five years and have paid Medicare taxes through employment for a certain period (usually at least 10 years).
Under 65 with certain disabilities: If you have received Social Security Disability benefits for 24 months.
Any age with End-Stage Renal Disease (ESRD): Requiring dialysis or a kidney transplant.
Any age with Amyotrophic Lateral Sclerosis (ALS): You are eligible for Medicare immediately upon receiving Social Security disability benefits for ALS.
Medicare is typically broken down into four main parts:
Medicare Part A (Hospital Insurance):
Covers: Inpatient hospital care, skilled nursing facility care, hospice care, and some home health care.
Cost: Most people do not pay a monthly premium for Part A if they or their spouse paid Medicare taxes for a sufficient number of years (usually 10 or more).
Medicare Part B (Medical Insurance):
Covers: Medically necessary doctors' services, outpatient care, home health services, durable medical equipment, mental health services, limited outpatient prescription drugs, and many preventive services (like certain vaccines and cancer screenings).
Cost: Most people pay a monthly premium for Part B, which can be higher based on income. There is also an annual deductible and typically a 20% coinsurance for most services after the deductible is met.
Medicare Part C (Medicare Advantage):
Covers: These are Medicare-approved health plans offered by private companies that provide all the benefits of Part A and Part B.
Often includes: Prescription drug coverage (Part D) and may offer additional benefits not covered by Original Medicare (Part A and Part B), such as vision, hearing, dental services, and fitness programs.
Network: You typically need to use doctors and hospitals within the plan's network (except for emergencies).
Medicare Part D (Prescription Drug Coverage):
Covers: Helps cover the cost of prescription drugs. These plans are offered by Medicare-approved private insurance companies.
Options: Available as a stand-alone plan or as part of a Medicare Advantage Plan (Part C).
Cost: Involves monthly premiums, deductibles, and co-payments/coinsurance, which vary by plan.
Original Medicare: This refers to Part A and Part B, managed directly by the federal government.
Medicare Supplement Insurance (Medigap): These policies are sold by private companies and help pay some of the out-of-pocket costs (like deductibles, copayments, and coinsurance) that Original Medicare doesn't cover. You must have both Part A and Part B to purchase a Medigap policy.
What Medicare generally doesn't cover: Most dental care, eye exams (for glasses or contacts), hearing aids, cosmetic surgery, and most long-term care (like nursing home stays for custodial care).