Finding the services and supports you need can be incredibly difficult, especially if you’re living with a disability. But if you learn all you can about your options, you’ll be in a better position to pursue the help you’re entitled to. One of the most promising assistance resources to consider is Medicare. If you’re new to this government program, you’re in the right place. Read on as we dive into all things Medicare.
What is Medicare?
Medicare is federal health insurance for eligible individuals who are (1) over 65 years old or (2) under 65 and eligible based on disability. It pays a portion of medical expenses for those who qualify.
What’s Covered Under Medicare?
The coverage you can expect through Medicare depends on which parts you participate in. There are four parts under Medicaid – A, B, C, and D:
- Part A: Hospital Insurance – Coverage for when you receive care at a hospital, skilled nursing facility (following a visit to the hospital), or a critical access hospital.
- Part B: Medical Insurance – Provides coverage for medically necessary expenses for doctor visits and preventive services. If you have this coverage, things like routine doctor appointments, durable medical equipment (DME), outpatient prescriptions, and ambulance services will be covered.
- Part C: Medicare Advantage – These are medical plans offered by Medicare-approved companies. Under one of these private plans, you’ll have Part A and Part B benefits in addition to any dental, vision, and wellness coverage available under the plan.
- Part D: Prescription Drug Coverage – This is optional prescription drug coverage available to Medicare beneficiaries (both brand-name and generic prescriptions may be covered).
What’s Not Covered Under Medicare?
Medicare doesn’t cover everything. Here are the main things that Medicare regularly denies as non-covered:
- Massage therapy.
- Eye exams or an eyeglasses prescription.
- Physical exams.
- Hearing aids.
- Exams for hearing aid fittings.
- Services received from a doctor who’s out of the Medicare network.
- The majority of dental care services.
Learn more on the Medicare website.
How is Medicare Different from Medicaid?
Medicaid is a state and federally funded program that provides health coverage for low-income individuals and families. And Medicare is a federal health insurance program mainly for people aged 65 and older or those with certain disabilities. The main differences between the two programs lie in the following areas:
- Main basis. Medicare’s eligibility criteria concern age or disability status, while Medicaid eligibility hinges on income and need.
- Management. Medicare is managed totally by the government. The Medicaid program is managed at both the federal and state levels.
- Uniformity. Medicare is consistent across the U.S., and Medicaid varies by state.
- Cost. Medicaid is usually much more affordable than Medicare – often free.
How Do You Get on Medicare?
To get started with Medicare, the easiest way is to apply online at ssa.gov/medicare. You can sign up for Part A (hospital insurance) and Part B (medical insurance) there, or just Part A if you’re still covered through an employer plan and want to delay Part B. If you’re turning 65 and already have Social Security, you’ll be enrolled automatically. If not, you’ll need to apply.
You can also apply by calling Social Security at 1-800-772-1213 Monday through Friday, 8 a.m. to 7 p.m. If you have End-Stage Renal Disease (ESRD), let them know when you call that you’re applying because of your condition.
You can also make an appointment to visit your local Social Security office—just be sure to schedule ahead.
After you apply, you can check the status of your application online.
So, there you have it – everything you need to know about Medicare. We hope you found all the information you were looking for, and we wish you the best as you pursue the benefits available to you.
