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Medicare Health Insurance

Medicare is a federal health insurance program that helps U.S. residents who are disabled or who are 65 years of age or older. People who are eligible for Social Security automatically qualify for Medicare hospital insurance (Part A) when they turn 65. Medicare, like other insurance programs, does not pay the entire medical bills. Medicare coverage is divided into four parts identified as Part A, B, C, and D. Original Medicare provides basic coverage for hospitals (Part A) and doctors and outpatient services (Part B). Services are provided through any doctor or hospital that accepts Medicare.

Medicare Card

The Health Insurance Marketplace of the Affordable Care Act (ObamaCare) is not part of Medicare and does not affect the coverage of Medicare. The Marketplace is intended for persons who don't have health insurance coverage. It is against the law for someone who knows that you have Medicare to sell you a Marketplace plan.

Medicare coverage comes in four parts. Here is a brief summary:

PART A  Helps pay for stays in hospitals and nursing facilities. You don't pay monthly premiums for Part A if you or your spouse paid sufficient payroll taxes while working.

PART B  Helps pay for doctors' services in and out of the hospital, and for outpatient care. It also covers some medical equipment and supplies administered in a doctor's office. You pay monthly premiums for Part B. Medicare typically pays 80 percent of the approved cost of each service.

PART C  Provides an alternative way to receive Medicare services through Medicare Advantage, which is administered through private managed-care plans such as HMOs and PPOs. These plans must cover all the same services as traditional Medicare Part A and B, but may charge lower copays. The plans may also offer dental, vision and hearing care. Medicare Advantage plans may restrict your choice of doctors and charge higher copays for going outside the network.

PART D  Helps pay for prescription drugs that you use at home. This coverage may be obtained by joining a private Part D drug plan for an additional premium, or by enrolling in a Medicare Advantage plan that includes Part D coverage.

Routine expenses not covered by Medicare:

The gaps in Medicare services may be covered by buying private insurance (Medigap coverage). The coverage of Medigap insurance plans is standardized and regulated by the government.

Medicare does not pay for long-term care, custodial care, private-duty nurses, private room, blood transfusions at home, care received outside the U.S., routine dental care and dentures, prescription drugs outside the hospital, nursing care at home, cosmetic surgery, routine foot care, eyeglasses, hearing aid, or personal comfort items such as a telephone or a television in your hospital room.

Prevent Medicare Fraud
If you already have Medicare insurance, safeguard your account information and verify carefully your statements to make sure that all Medicare charges are for services that you received. Medicare loses millions of dollars every year through fraudulent claims that result in higher health care costs. Give your Medicare information only when you visit health providers. Look out for some of these fraud schemes:

Medigap (Supplemental Insurance) Policies
A Medigap policy is health insurance sold by private insurance companies to cover the gaps in coverage of the Original Medicare Plan. All Medicare participants are guaranteed acceptance for supplemental coverage if they act within six months of turning age 65 or enrolling in Part B at age 65 or older. People with Medicare are encouraged to review their coverage and benefits during the Medicare Open Enrollment period (usually October 15 to December 7) and make changes that will take effect the following year. Medigap policies help pay some of the health care costs that the Original Medicare Plan does not cover. If you have coverage under the Original Medicare Plan and you also have a Medigap policy, then both of these plans will pay their corresponding shares of health care costs.

Private insurance through a former employer can sometimes be continued or converted into a supplemental policy after retirement. The converted coverage has the advantage that there are no waiting periods or exclusions for pre-existing health conditions, and premiums may be partially or completely paid by the employer.

Insurance companies can only sell standardized Medigap policies with specific benefits that can be compared easily. There are 12 different standardized Medigap policies (Medigap Plans A through L) which must follow Federal and State laws. A Medigap policy must be clearly identified on the cover as "Medicare Supplement Insurance". Each plan, A through L, has a different set of basic and extra benefits. It is important to know that if you join a Medicare Advantage Plan (Part C), your Medigap policy will not work. This means it will not pay any deductibles, copayments, or other cost-sharing under your Medicare Health Plan. Therefore, you may want to drop your Medigap policy if you join a Medicare Advantage Plan.

Applying for Medicare
You should sign up for Medicare a couple of months before your 65th birthday so that your benefits are in place when you turn 65. You have three months after your 65th birthday to enroll in Medicare, but if you postpone your application beyond that time, you have to wait until the general enrollment period and you may have to pay a higher premium. These are the two steps for applying for Medicare:

Although you can receive Medicare benefits at age 65, the age for achieving full retirement benefits has been adjusted upward depending on the year of birth. Since there is a substantial reduction in the Social Security retirement benefits when retiring early, most people will choose to apply for Medicare first, and then apply at a later date for Social Security Retirement benefits.

Age for Full Social Security Retirement Benefits
 Year of Birth   Full Retirement Age 
 1937 or earlier  65
 1938  65 and 2 months
 1939 65 and 4 months
 1940 65 and 6 months
 1941 65 and 8 months
 1942 65 and 10 months
 1943 - 1954 66
 1955 66 and 2 months
 1956 66 and 4 months
 1957 66 and 6 months
 1958 66 and 8 months
 1959 66 and 10 months
 1960 and later 67

You can receive Social Security benefits by retiring as early as age 62, but the amount that you get is reduced by 25% if you retire that early. To get your full Social Security Benefit, you have to claim at your full retirement age, as indicated in the table above. Your yearly income increases by 8 percent for every year that you defer getting your benefits between ages 66 and 70. Spouses who did not work enough to get Social Security benefits can retire at 66 on half of the spouse's full benefit. A widow or widower can switch to survivor's benefit which is generally equal to what the diseased spouse was getting.

  1. Medicare -- The Official U.S. Government Site

© Copyright  - Antonio Zamora