Who's eligible for Medicare?
When Medicare began, only U.S. citizens ages 65 or older could sign up. But now, the enrollment criteria have expanded so that many more people can benefit, including:
- Noncitizen permanent residents: Green card holders ages 65 and up can get Medicare if they've lived in the U.S. for at least five years or if they've been married to a fully insured U.S. citizen or permanent resident for at least one year.
- People with disabilities: People of any age with disabilities also qualify for Medicare, as long as they've received Social Security disability benefits for at least 25 months.
- People with certain health problems: People with end-stage renal disease or Lou Gehrig's disease may be able to get Medicare benefits immediately.
What are the different parts of Medicare?
It can be helpful to think of Medicare as a set of puzzle pieces that fit together to create a well-rounded health insurance picture. Here are the components of Original Medicare, what President Johnson originally signed into law in the 1960s:
Medicare Part A
Known as Medicare's hospital insurance, Part A covers more than just hospitalizations; it also covers home health, hospice, mental health stays and skilled nursing facilities.
Medicare Part B
Known as Medicare's medical insurance, Part B covers both preventive health care — such as flu shots and cancer screenings — as well as medically necessary services, like seeing a doctor for a health problem. It also covers services like ambulance rides, clinical research and durable medical equipment.
Medicare Parts A and B also cover mental health, with inpatient stays covered under Part A, and family counseling, psychotherapy and psychiatry covered under Part B. You also get one free depression screening per year.
Since the start of Medicare, the government has added several more choices so that people can build the right plan for them. Two of the biggest additions include:
Medicare Part C
Also known as Medicare Advantage, Medicare Part C is a bundled plan offered through Medicare-approved private insurance companies. It combines Parts A and B into one health plan — usually a preferred provider organization (PPO) or health maintenance organization (HMO). It often includes prescription drug coverage, too. While Medicare Part C offers the same benefits as Parts A and B, there are some trade-offs, including a potentially limited choice of doctors.
Medicare Part D
Part D adds prescription drug coverage to Parts A and B. Part D is also offered through Medicare-approved companies, such as private insurers.
There are also different types of Medicare Advantage plans. These options generally make the most sense for people with special health needs or preferences for how they get and pay for health insurance. These plans include:
- Medicare private fee-for-service plan: This type of plan designates the fees it pays providers for health care services and the costs you'll pay those providers.
- Medicare special needs plan (SNP): This plan provides specialized coverage to people with specific health conditions. It might be of interest to you, for example, if you have cancer and need to see certain doctors or have certain treatments. This type of plan is only offered in some places.
- Medicare medical savings account (MSA): This is a high-deductible plan that comes with a special savings account for health care costs. It doesn't cover prescription drugs; you'd have to buy Part D to get that benefit.
You may have other Medicare coverage options, too — such as Program of All-Inclusive Care for the Elderly (PACE), special pilot plans or Medicare Cost Plans. Not everyone qualifies for these plans, and they vary based on where they operate.
What is Medigap?
You may have seen commercials or heard radio ads about Medigap, a type of supplemental insurance you can buy through private insurance companies. As an extra policy to help pay your portion of health care costs, Medicare supplement plans are designed to go along with Original Medicare, rather than replace it. You can't buy a Medigap plan if you have Medicare Advantage, and it doesn't include prescription drug coverage. To buy a Medigap plan, you must have Medicare Parts A and B.
What does Medicare not cover?
While Medicare covers many different health care services, it doesn't cover everything. Take heed if you expect to need any of these types of care:
- Long-term custodial care
- Eye exams, dental care and dentures
- Cosmetic surgery
- Hearing aids and hearing aid fitting
- Regular foot care
If you want to purchase Medicare but need any of these health care services, be sure to make financial preparations to pay for them.