Medicare; Everything You Need to Know 


You may often wonder what Medicare is, who is eligible, and what makes one eligible. Apart from eligibility, you should also know how medicare works and its parts. Medicare is a healthcare insurance program administered by the US federal government that provides coverage for qualified individuals and their families aged 65 and older. It also covers those with end-stage renal disease.

Both the taxpayer and premiums fund Medicare. The current cost of Medicare is 3% of GDP annually, less than other countries like the UK, Canada, France, Germany, Australia, etc. Medicare should be considered great healthcare insurance in the United States because it covers everything from long-term care to dialysis.

Who is Eligible?
Medicare is open to all individuals aged 65 or older who meet certain criteria. The following are some of the requirements for eligibility under Medicare:

1. Must be an American Citizen
An individual is eligible for Medicare if they are an American citizen or permanent resident alien. If one is in the United States on a temporary visa, they are not eligible for it.

2. Residence
You must also live in the US and earn taxable income from gross earnings, interest and dividend income, pensions, unemployment compensation, etc. The only exceptions are those who live outside the US with a visa that specifically excludes social security benefits regardless of their US citizenship status or non-residency status within the US.

3. Age
An individual is eligible for Medicare if they are 65 or older.

4. End Stage Renal Disease
Individuals who require dialysis or a kidney transplant are eligible for a Social Security Disability Insurance (SSDI) benefit. They may also qualify for Medicare as long as they otherwise meet the eligibility requirements described above and include meeting the 24-month Medicare waiting period.

What are the Parts of Medicare
Medicare is divided into two distinct parts, A and B. The two are substantive and cover different persons with differing needs. The two parts are further divided into four subparts. 

Part A
This part of Medicare is also called hospital insurance and is administered by the Social Security Administration. Part A enables inpatient hospital care, skilled nursing facility care, home health services, and hospice care. To be eligible for this, one must meet a certain requirement of 40 credits over ten years, including the 20 credit rule (10 years out of 40) after 1998.

Part B
Also called supplementary medical insurance, part B requires one to pay a premium, which increases by CPI. This covers outpatient hospital services, home health care, skilled nursing facility, and certain types of physician’s services.

How Do You Enroll for Medicare
Normally you need a legal process to qualify for any aid. Medicare is no exception. Here you will go through a series of steps.

  • Step 1. Complete a medicare application form and send it to the local medicare office.
  • Step 2. The medicare office will confirm your eligibility at this stage and give you a letter of confirmation that you are eligible to receive Medicare benefits.
  • Step 3. Later on, if you wish to enroll, the federal medicare administration will contact your state Medicaid agency for further information about your eligibility and need for coverage to reimburse your premium charged by insurance companies or health care providers, etc.
  • Step 4. After you have completed the enrollment process, you will be issued an identification card that has your name and doctor’s signature.

The Medicare 24-Month Waiting Period
You are required to wait for 24 months before you can enroll for Medicare. This ensures that everyone has a fair chance to be registered and insured by the program. This is considered the individual’s waiting period. If an individual gets covered by any private insurance during this time, they will have to wait for a further two months after Medicare coverage ends before they can apply for it again. 

False Claims Act
The federal government takes the false claims to act very seriously. Here they will prosecute the health care providers who knowingly submit false claims to the Medicare program. The penalty can be a fine of up to $10,000 or even more. If you were one of the victims in this circumstance, you are encouraged to report it to the local authorities. This is because there is only a limited amount of available dollars for the program, and any fake claims will naturally reduce funds for people who genuinely need these services.

Medicare Frauds
This is one of the biggest scams you can encounter while applying for Medicare. It has been reported by the US Department of Health and Human Services that false Medicare beneficiaries receive benefits totaling $60 billion every year. The most prevalent type of scam is identity theft. More than two million Americans were victims of this in 2017. Another common type of scam involves ‘pill-mills,’ medical clinics dispensing illegal controlled substances.

What Happens If You Fail to Enroll For Medicare
There can be dire consequences if you fail to enroll at the right time. You may lose your medicare benefits and pay a fine of $250 per month if you fail to enroll for two months. It is recommended that you enroll in the program when you turn 65 to enjoy your benefits without any problems. 

Where Can You Enroll
Medicare is sponsored by the federal government and is administered by the Social Security Administration. You can enroll for it at any of the SSA offices located in your local municipalities. You can also enroll online. You can also call the Social Security offices. You can choose any method depending on your convenience and financial status.