The Basics Of Medicare Eligibility And Coverage

American citizens and permanent residents aged 65 years and older can avail of federal health insurance coverage under the Medicare program. Aside from the age requirement, Medicare eligibility is also dependent on one having paid money or taxes into the Medicare program for at least ten years. However, people with a disability or permanent kidney failure can receive Medicare benefits even if they are less than 65 years old.

Medicare offers several benefits such as hospital insurance, medical insurance and prescription drug plans. There is another part that deals with a type of insurance plan called Medicare Advantage. The following discusses each benefit in a little more detail:

Most people don't have to pay for Part A, since this is already paid for in advance by their Medicare contributions, which are automatically deducted from their paycheck. Medicare subsidizes inpatient costs at hospitals, clinics, or ambulatory surgical centers. It can also be used to help pay for home health care, skilled nursing service and hospice care, provided that certain criteria are met.

Part B: Medical Insurance. This benefit helps pay for some services and products not covered by part A, which are mostly outpatient costs. These include professional fees, laboratory and diagnostic tests, x-rays, blood transfusions, renal dialysis, drugs covered by Medicare and medical equipment such as canes, walkers and wheelchairs. This optional benefit requires premium payments, which can be higher if you don't sign up for it when you become eligible.

Part D helps pay for prescription medicine and other drugs not covered by Part B. It also provides protection from higher expenses related to this in the future. Also approved and regulated by Medicare, prescription plans are actually administered by private companies.

Part C, or the Medicare Advantage plan, allows Medicare beneficiaries to receive their benefits through private health insurance plans, instead of the original Medicare plan (Parts A and B). These plans are required to offer coverage that is equal or greater than that of the original Medicare program, but they do not have to cover every benefit in the same way. The policies usually cover services that are medically essential and the patient can be charged non-standard deductibles, co-payments, or coinsurance for these services.

However, Medicare is not meant to cover all the medical expenses of its beneficiaries. There is also the concern that the number of beneficiaries will soon outnumber the working population who are the ones funding the Medicare program. Some predict that, if this trend continues, the federal government will not be able to sustain Medicare after 2018 or so.

However, the advantages still outweigh the disadvantages. Beneficiaries should take the time to learn about Medicare eligibility rules and coverage. After all, education is the key in making the most of this program.