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Texas Medicare for Tarrant County

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Texas Medicare for Tarrant County

Understanding Medicare and its Various Parts

Health-care costs have been a growing issue in the United States for years. Many people might worry that they can’t afford all their medical bills or insurance. This could leave some people with tough decisions about their health and finances.

The Medicare program was developed by the government to protect the health and well-being of millions of Americans. Over time, Medicare has provided more and more Americans with access to the quality and affordable health care they need. If you’re a Medicare beneficiary or helping someone who is, you may want to read this article to get an understanding of the Medicare program and the parts of Medicare. Understanding the basics of Medicare may be useful when you’re deciding on Medicare coverage to fit your individual needs.

What is Medicare, and who can get it?

Medicare is a government health insurance program administered by the Centers for Medicare & Medicaid Services (CMS). According to a CMS report, over 55 million people were Medicare beneficiaries as of 2015, including over 39 million enrolled in Medicare Part D (prescription drug coverage).

Can you answer yes to at least one of the following statements?

  • I am 65 years of age or older.
  • I am under 65, but I receive disability benefits from the Social Security Administration (SSA) or the Railroad Retirement Board (RRB).
  • I have amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease).
  • I have end-stage renal disease (ESRD), which is permanent kidney failure that requires a transplant or dialysis.

If so, then you are likely to be eligible for Medicare benefits. You must be at least 65 years old and an American citizen or permanent legal resident of at least five consecutive years. You may also qualify at any age through disability or by having end-stage renal disease or amyotrophic lateral sclerosis.

Tarrant County Medicare explained

There are four main “parts” of Medicare insurance: Part A, Part B, Part C, and Part D. Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) together make up Original Medicare. Medicare Part C, also known as Medicare Advantage, and Medicare Part D (prescription drug coverage) programs that let you get Medicare plans through private insurance companies that contract with Medicare. There is also Medicare Supplement insurance (also called Medigap), which is sold by private companies.

Original Medicare

Original Medicare refers to Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) and is in some ways central to your Medicare coverage. That is, the Medicare plan options described below require you to be enrolled in Medicare Part A, Part B, or both (depending on the type of plan); some plan options are meant to work alongside your Original Medicare coverage, while Medicare Advantage offers an alternative way to get that coverage – more on this follows later in this article.

Most of those eligible are automatically enrolled in Medicare Part A and Part B when they turn 65; if you’re already receiving Social Security Administration (SSA) or Railroad Retirement Board (RRB) benefits, you’ll “age in” automatically. If you’ve been receiving SSA or RRB disability benefits for 24 consecutive months, Medicare enrollment is also automatic for you. On the other hand, if you have ALS, you’ll be automatically enrolled the same month that you start receiving SSA or RRB disability benefits.

Some people need to sign up for Medicare. If your circumstances don’t fit the criteria above, or if you have ESRD, you’ll need to enroll in Medicare through the SSA or RRB.

  • To contact the Social Security Administration, you can visit their website or call 1-800-772-1213. TTY users can call 1-800-325-0778. Representatives are available Monday through Friday, from 7 AM to 7 PM.
  • If you worked for a railroad, you can visit the Railroad Retirement Board website or call 1-877-772-5772. TTY users call 1-312-751-4701. Monday through Friday, 9 AM to 3:30 PM, to speak to an RRB representative.

Most Medicare beneficiaries do not pay a premium for Medicare Part A. In brief, Medicare Part A covers inpatient care in facilities such as (but not limited to) hospitals and skilled nursing facilities. Medicare Part A also covers hospice care and limited home health care.

Medicare Part B is medical insurance that covers doctor visits, medically necessary services, and supplies, preventive services, and certain other items and services. Beneficiaries typically have to pay a premium to receive Part B coverage.

The federal government manages Original Medicare, which operates as a fee-for-service plan. Most beneficiaries pay a deductible as well as a copayment or coinsurance for these services.

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.