Medicare
Is the United States' federal health insurance program for individuals 65 or older and some younger people with disabilities, End-Stage Renal Disease (ESRD), or Amyotrophic Lateral Sclerosis (ALS).
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Eligibility:
Eligibility:
Generally, you are eligible if you are a U.S. citizen or have been a legal resident for at least 5 years and meet one of the following criteria:
Age 65 or older: You or your spouse has worked for at least 10 years (40 quarters) in Medicare-covered employment. If you haven't worked enough, you may still be eligible by paying a monthly premium.
Under 65 with a disability: You have received Social Security disability benefits for 24 months or have ESRD or ALS.
Part A (Hospital Insurance): Helps cover inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care. Most people don't pay a monthly premium for Part A if they or their spouse have a sufficient work history. The 2025 deductible is $1,676 per benefit period. Coinsurance costs apply for hospital stays exceeding 60 days and for skilled nursing facility stays exceeding 20 days.
Part B (Medical Insurance): Helps cover services from doctors and other healthcare providers, outpatient care, home health care, durable medical equipment, and many preventive services. Most people pay a monthly premium for Part B. The standard monthly premium for 2025 is $185, and there's an annual deductible of $257. After the deductible, you typically pay 20% of the Medicare-approved amount for most services. Higher-income individuals may pay a higher premium based on their income.
Part C (Medicare Advantage): These "all-in-one" plans are offered by private companies approved by Medicare.They bundle Part A, Part B, and usually Part D (prescription drug coverage). Medicare Advantage plans may offer extra benefits like vision, hearing, and dental care. Costs vary by plan, including premiums, deductibles, copays, and coinsurance. You must have Part A and Part B to join a Medicare Advantage plan.
Part D (Prescription Drug Coverage): Helps cover the cost of prescription drugs. It's offered by private insurance companies that have contracted with Medicare. Enrollment is voluntary and requires paying a monthly premium, which varies by plan. There may also be a deductible, copays, and coinsurance. In 2025, there will be a $2,000 cap on out-of-pocket costs for drugs covered by your Part D plan. Higher-income individuals may pay a higher premium based on their income.
Important Considerations:
Original Medicare (Parts A & B): You can see any doctor or hospital that takes Medicare, anywhere in the U.S. You may also want to consider purchasing a Medigap (Medicare Supplement Insurance) policy from a private company to help cover out-of-pocket costs like deductibles and coinsurance. Medigap policies generally don't cover prescription drugs.
Medicare Advantage (Part C): These plans often have networks, and you may need to see doctors within the plan's network to have lower costs. They may also require referrals to specialists. However, they often include Part D and additional benefits not covered by Original Medicare.
Enrollment: There are specific enrollment periods for Medicare. The Initial Enrollment Period (IEP) is a 7-month window surrounding your 65th birthday. There are also General Enrollment Periods and Special Enrollment Periods under certain circumstances. It's important to enroll on time to avoid late enrollment penalties.
Costs: In addition to premiums, you'll likely have other out-of-pocket costs like deductibles, copayments, and coinsurance, depending on your coverage.
For detailed and personalized information about Medicare, it's best to visit the official Medicare website (https://www.medicare.gov/) or call 1-800-MEDICARE. You can also get help from your local State Health Insurance Assistance Program (SHIP).
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