Irving Texas Medicare Plans

MEDICARE EXPLAINED

Medicare is the federal health insurance plan designed to help certain populations meet their health care needs. Medicare is like a regular private insurance plan, except the government runs it. Specifically, it is run by a federal agency called the Centers for Medicare and Medicaid Services (CMS). While many people confuse Medicare and Medicaid, the two are, in fact, different. Medicare is for older people or people with disabilities, while Medicaid is for people with limited incomes. Read more to learn more about the basics of Medicare.

Are You Eligible for Medicare?

Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years old and a citizen or permanent resident of the United States.

If you are not 65, you might also qualify for coverage if you have a disability or with End-Stage Renal Disease (permanent kidney failure requiring dialysis or transplant).

Here are some simple guidelines. You can get Part A at age 65 without having to pay premiums if:

You already get retirement benefits from Social Security or the Railroad Retirement Board.
You are eligible to get Social Security or Railroad benefits but have not yet filed for them.
You or your spouse had Medicare-covered government employment.

If you are under 65, you can get Part A without having to pay premiums if:

You have received Social Security or Railroad Retirement
Board disability benefit for 24 months. You are a kidney dialysis or kidney transplant patient.

While you don’t have to pay a premium for Part A if you meet one of those conditions, you must pay for Part B if you want it. It is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you don’t get any of the above payments, Medicare sends you a bill for your Part B premium every 3 months.

STRUCTURE OF MEDICARE

Medicare is funded mainly by taxpayers. In particular, it is funded by income tax paid into the Social Security and Medicare fund and partly by premiums that Medicare participants pay. Additional payment depends on the type of plan.

There are two main plans: Original Medicare and Medicare Advantage Plans. Original Medicare is paid for by the federal government but does not include prescription drug coverage. Medicare Advantage Plans are different. They are Medicare-approved plans offered through private insurance companies that often include prescription drug coverage with a monthly premium.

Medicare is structured in three parts: Part A, B, and D. Medicare Advantage Plans are often referred to as Part C. Part A mainly covers hospital and skilled nursing facility costs, Part B covers mostly outpatient care, and Part D covers prescription medications. All 3 of these parts allow people to have more flexibility when choosing healthcare providers. Generally, people can choose whatever doctor or hospital they want as long as that provider is enrolled in Medicare.