Health Insurance in United States of America

Medicare Part A & B

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Medicare Part A & B called as Original Medicare. Which covers Hospital, physician visits and outpatient procedures.

What are the eligibility for Medicare Part A & B?

Medicare Part A & B are available to people with

  • Age 65 or older
  • Disability
  • ESRD-End Stage Renal Disease.
Differences between original Medicare and Medicare Advantage?
Original Medicare Medicare Advantage
Includes Medicare Part A & B. Medicare Part C Includes Medicare Part A & B, and usually drug coverage i.e. Medicare part D.
Covers Hospitalization, services of office providers and outpatient services. Covers services of doctors in MCO set up. Managed Care Organizations are the health insurance companies established by group of doctors assuring promised services to enrollees throughout the year for the accepted premium.
You can avail for separate drug plan to get Medicare Part D. Most of the plans includes Medicare Part D Plan.
You can choose or consult doctor or hospital anywhere in United States which accepts Medicare. In most cases, you need to consult the doctor or hospital who are in the Insurance plans network. Some private insurance companies offer non-emergency coverage out of network at a higher cost.
It covers most of the Medically required services. It doesn’t cover hearing, dental, vision and some routine exams. It covers all the Medically necessary services that original Medicare covers. Along with that most of the plans cover hearing, dental, vision and some routine exams.
Not require any approval to cover the care Some of the care requires an approval to cover the services.

 

Medicare Part A:

Medicare Part A called as Hospital Insurance. It covers Inpatient care in Hospitals, SNF-Skilled Nursing facility care, Hospice & HHC-Home Health Care.

Do you have to pay a premium for Medicare part A?

Most of the individual get a premium free Medicare part A, but some have to pay a premium to enroll in Medicare part A plan.

When you are eligible to avail a premium free Medicare part A?

Premium free Medicare part A is available if you or your spouse paid taxes under FICA (Federal Insurance Contribution Act) for a certain amount of time while working and you can avail this if

  • You already getting benefits from Social Security or RRB
  • You are eligible for social security or RRB but haven’t filed yet.
  • You or your spouse has Medicare covered government service.

An individual can avail premium free Medicare part A under age 65 if

  • You already getting benefits from social security of RRB disability benefits for 24 months.
  • You have ESRD-End Stage Renal Disease or ALS-Amyotrophic Lateral Sclerosis and meet certain requirements
How to enroll in Medicare part A?

You will be automatically enrolled in premium free Medicare Part A at the age 65, if an individual already receiving Social Security or RRB benefits at least 4 months prior to turning age 65 and residing in the United States.

People who are not receiving a Social Security or RRB benefit are not automatically enrolled. This individual must apply by contacting Social Security.

How to enroll for people age 65 or older, who must pay a premium for Medicare part A?

An individual who must pay a premium for Medicare part A do not automatically get Medicare when they turn age 65, they must

  • File an application to enroll by contacting SSA-Social Security Administration.
  • Enroll during a valid enrollment period.
  • Also, they should enroll in or already have Part B.

 

Medicare Part B:

Medicare Part B called as Medical Insurance. It covers doctor visits, Outpatient procedures, Durable medical equipment (like wheel chair, crutches) & some preventive services (like flu shots). In Medicare part B you will pay a premium every month. It is important to pay attention to the deadlines when enrolling Medicare part b. Suppose when you are first eligible and if you don’t sign up, then you have to pay a late enrollment penalty which will be added to the monthly premium cost as long you have Medicare part b.

The eligibility rules of Medicare part b depend on whether a person is eligible for premium free Medicare part a or individual have to pay a premium for Medicare part A.

How an individual can enroll in Medicare part B?

If an individual eligible for premium free Medicare part A, then an individual is also eligible to enroll in Medicare part B once he/she entitled to part A.

If an individual must pay premium to avail Medicare part A, then an individual to enroll in Medicare part B must meet the following requirements:

  • Age 65 or older.
  • United States resident.
  • Either United State Citizen or be an alien who has been legally admitted for permanent residence and has been residing in the United States for five continuous years prior to the month of filing a request for Medicare.
Can you ever get both Medicare Part A and B coverage at the same time?

Yes, when you are an inpatient in a hospital, it possible to get Medicare part A and B coverage at the same time.

Example: Medicare part A generally covers medically necessary surgery and certain hospital costs, Medicare part B cover doctor visits while you’re an inpatient.