One of the health insurance programs offered by the United States government is called Medicare. Patients who have reached the terminal stage of renal illness and those at least 65 years old are eligible for coverage under this plan.
Medicare comprises different plans, each of which addresses a specific area of health care; nevertheless, the insured are responsible for paying premiums for some of these plans. Although this enables the program to provide members with additional options in terms of pricing and coverage, it does so at the expense of adding complications for those interested in enrolling.
How the Medicare System Operates
The United States federal government provides funding for the national health insurance program known as Medicare. In 1965, the Social Security Act was amended by Congress to establish this program, which was designed to provide coverage to those aged 65 and older who did not have health insurance.
People younger than 65 years old who have some disabilities and those who have end-stage renal disease or ALS are now eligible for coverage under the program, which is now administered by the Centers for Medicare and Medicaid Services (CMS) and expands coverage options. The Medicare program is comprised of four distinct parts, each of which addresses a distinct facet of medical care:
- Hospital insurance is provided through Medicare Part A, including coverage for skilled nursing facilities, hospice care, and in-home care.
- Visits to the doctor, outpatient treatment, care provided in the patient's home, and durable medical equipment are all covered under Medicare Part B., as well as tests aimed toward prevention.
- Plans offered by private firms that Medicare has recognized to provide benefits under Medicare Parts A, B, and often Part D is referred to as Medicare Part C, also known as Medicare Advantage.
- Prescription medication is covered under Medicare Part D.
Who Qualifies for Medicare?
Anyone who has legally resided in the United States for at least five years and is 65 or older is eligible for Medicare coverage. However, eligibility is contingent on meeting several criteria. Anyone eligible for Social Security payments is automatically enrolled in Parts A and B of the program. Because having Part D coverage is voluntary, enrolling in the program is required to have it.
Individuals under 65 receiving Social Security Disability Insurance may be eligible. Those who receive Social Security Disability Insurance (SSDI) must typically wait 24 months after they get their first check before they become qualified for Medicare. However, the program exempts anyone with amyotrophic lateral sclerosis (ALS) or permanent kidney failure from this requirement. You may sign up for Social Security online by visiting the Social Security Administration (SSA) website.
If either the insured individual or their spouse has paid into Medicare in the form of payroll taxes for ten years or more, they are exempt from having to pay the monthly premium for Medicare Part A, which pays for hospital stays and other types of inpatient treatment. You are the one who is responsible for paying the premiums for the many other components of the Medicare program.
By the FICA, most of the program's funding comes from payroll taxes. The FICA payroll taxes that workers are responsible for paying as of the year 2022 include a 1.45% Medicare tax on all taxable wages, as well as a 6.2% Social Security tax on yearly earnings of less than $147,000 ($160,200 in 2023) The employee's employer is responsible for paying the same proportion on their behalf. Earnings over $200,000 per year for single taxpayers and $250,000 for married couples filing jointly are subject to an extra Medicare surtax of 0.9%.
Enrolling in Medicare
When you reach the age of 65 and are already receiving Social Security benefits, you will be registered in Medicare Part A, which pays for inpatient treatment, and Part B, which pays for outpatient care at a doctor's office automatically. You are responsible for enrolling in Medicare Part D if you want coverage for prescription drugs under that program; enrollment is not automatic.
If you are not already receiving benefits from Social Security, you may sign up for Medicare by using the website provided by the Social Security Administration. You should take this action within the seven-month window surrounding your 65th birthday to avoid penalties and lengthy waiting periods before your insurance coverage kicks in.
You may sign up for Medicare Supplement Insurance, often known as Medigap, during the six-month enrollment period that begins the month you turn 65 and are enrolled in Medicare Part B. This period begins when you are eligible for Medicare Part B. If you sign up for a Medigap plan within that period, the private insurers that provide such policies are compelled to accept you as a customer. If you don't, there is no assurance that they would offer you a Medigap plan; if they do, they could charge you a higher premium for the coverage.
