Medicare Overview
The first step is finding out if you’re eligible. Medicare is a federal program that offers health insurance to American citizens and other eligible individuals based on age, disability or a qualifying medical condition. Medicare is individual insurance and doesn’t cover spouses or dependents.
Eligibility
To be eligible for Medicare, you must be a U.S. citizen or legal resident. Legal residents must live in the U.S. for at least 5 years in a row, including the 5 years just before applying for Medicare.
And, you must meet one of these requirements:
- Age 65 or older
- Younger than 65 with a qualifying disability
- Any age with a diagnosis of end-stage renal disease or ALS
Are you working past 65?
You still have an Initial Enrollment Period Even if you have coverage through an employer plan (yours or your working spouse’s), you have Medicare decisions to make at age 65. Your IEP happens when you turn 65 whether you continue to work or not.
Depending on the employer coverage you have, you may be able to delay enrolling in Medicare without penalty. Talk with your employer’s benefits administrator to understand your options and to determine if your coverage is considered “creditable.”
Medicare Part A
Part A covers hospital stays and most of the inpatient services
Coverage includes:
A semi-private room
Your hospital meals
Care in special units, such as intensive care
Drugs, medical supplies and medical equipment used during an inpatient stay
Lab tests, X-rays and medical equipment as an inpatient
Operating room and recovery room services
Some blood transfusions in a hospital or skilled nursing facility
Inpatient or outpatient rehabilitation services after a qualified inpatient stay
Part-time, skilled care for the homebound after a qualified inpatient stay
Hospice care for the terminally ill, including medications to manage symptoms and control pain
Medicare Part A
Part B covers hospital stays and most of the inpatient services
Coverage includes:
Doctor visits, including in the hospital
Annual Wellness Visit
Ambulatory surgery center services
Ambulance and emergency room services
Skilled nursing services
Preventive services, like flu shots or mammograms
Clinical laboratory services, like blood and urine tests
X-rays, MRIs, CT scans, EKGs and some other diagnostic tests
Some health programs, like smoking cessation, obesity counseling and cardiac rehab
Physical therapy, occupational therapy and speech-language pathology services
Diabetes screenings, diabetes education and certain diabetes supplies
Mental health care
Durable medical equipment for use at home, like wheelchairs and walkers
Some services may have limitations. Preventive services and screenings are covered on set schedules, such as a yearly flu shot. Other covered services and supplies must be medically necessary to diagnose or treat a disease or condition.
Additional Coverage
You may enroll in Medicare Part A, Part B or both. You may also add additional coverage such as a Medicare Advantage, Part D or Medigap plan.
You can stick with Original Medicare, or get more coverage. Here are your continued options:
- Medicare Advantage plans (Part C)
- Prescription drug plans (Part D) Medicare prescription drug plans (Part D)
- Medicare supplement insurance plans (Medigap)
Please contact Andrew Six Insurance to learn more about your options!
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8310 Northwest 39th Expressway
Bethany, OK 73008