A Beginner’s Guide to Medicare: What You Need to Know

A Beginner’s Guide to Medicare: What You Need to Know

In early 2020, about 30.4 million Americans did not have health insurance. According to the Urban Institute, many low-income Americans are uninsured because they can’t afford health insurance. To solve this problem, the federal government founded the Center for Medicare and Medicaid Services (CMS) agency to provide affordable healthcare programs, such as Medicare, to certain groups of Americans. Every year, hundreds of thousands of Americans access medical care through Medicare. For example, in 2018 alone, about 498,000 Americans in Nevada received Medicare coverage. Here’s everything you need to know about Medicare health insurance.

What Is Medicare?

Administered by the CMS federal agency, Medicare is a health insurance program that provides affordable and guaranteed coverage for Americans aged 65 years and above, some younger disabled ones, and those with End-Stage Renal Disease (ESRD). This program is useful for such people considering most private insurance companies do not cover high risks such as terminal illnesses, old age, or underlying conditions. In case they do, the costs of health insurance premiums are usually high even though the 2010 Affordable Care Act forbids this, says the U.S. Department of Health and Human Services (HHS).

Is Medicare Mandatory at Age 65?

There is no straight answer to this question because it all depends on your employment status. For instance, Medicare is mandatory at age 65 years, provided you are retired. However, if you are still working at this age, the size of your company will then determine whether you should sign up for Medicare or not. More specifically, if your company has less than 20 employees, then you should register for Parts A and B of Medicare insurance. On the other hand, working in a company with over 20 employees means that you probably have a substantial amount of employee group insurance, and hence, you may wait up to a later date before signing up for Medicare. Alternatively, you can register for Part A and delay other Medicare plans. Take note that late enrollment attracts penalties such as a 10% increase on your monthly premiums, according to the American Association of Retired Persons (AARP).

Coverage Options Available under Various Medicare Plans

Eligible residents of Las Vegas, Henderson, and Pahrump have access to Original Medicare plans, including:

  • Part A

    Also known as Hospital Insurance, Part A covers healthcare in a nursing facility, certain home care services, inpatient hospital stays, and hospice care. This plan is usually premium-free, provided you or your spouse paid taxes for a certain period during your working years.

  • Part B

    Also called Medical insurance, this coverage pays for preventive services, some doctors’ services, medical supplies, and outpatient healthcare services.

    Exclusions from these plans include, among others, eye care, hearing aids, dental care, and most prescription drugs. You can also sign up for Medicare Advantage plans, also known as Part C, which allows you to get coverage through a private insurer. Part C provides similar coverage as Parts A and B, except hospice care, per the U.S. Center for Medicare and Medicaid Services (CMS). The good news is you can also add other inclusions such as hearing, vision, and dental, depending on the plan you purchase. Medicare Part D provides prescription drug coverage, and you can also find it from private insurers or those with approval from Medicare.

Who Is Eligible for Medicare?

Typically, you are eligible for Medicare Part A if you fall in these categories:

  • You are an American citizen or permanent resident aged 65 years or older
  • You receive or are eligible for Social Security or Railroad Retirement Board benefits
  • You or your spouse paid Medicare taxes in your working years for a certain period
  • You receive or are eligible for disability benefits
  • You are a kidney patient

While you may not be eligible for Part A if you don’t meet these qualities, you can still access this plan, provided you pay premiums.

Costs Involved in Medicare Plans

Usually, Part A coverage is premium-free if you worked for at least 40 quarters and paid Medicare taxes during this period. However, if you only worked for 30-39 quarters, you will have to pay $259 worth of monthly premiums in 2021. Those who worked for less than 30 quarters will pay $471 per month on their Part A plan, as reported by Medical News Today.

In Medicare Part B, the amount of premiums depends on the size of your income, while Part D premiums depend on the type of plan you choose. Other costs involved in Medicare plans include:

  • Deductible

    In 2021, you will have to pay a $1,484 worth of deductible on Part A coverage, and this covers the first 60 days of your hospital stay.

  • Coinsurance

    For Part B, you will be charged a 20% coinsurance on outpatient services.

  • Copayment

    While this will vary from one plan to another, those with Part D coverage will have to pay a copayment on every prescription drug they purchase.

These are all the important things to know about Medicare. If you need more help concerning Medicare health insurance in Las Vegas, Pahrump, or Henderson, don’t hesitate to contact Medicare Advisors. Our experts are ready to take you through the available coverage plans and help you register within the required period.