Medicare is a federal health insurance program for U.S. residents aged 65 and older and some younger people with disabilities.

How Does Medicare Work?

Medicare is vital for ensuring healthcare coverage for millions of seniors and people with disabilities.

1. Coverage Components:
   
   • Part A: Covers hospital stays, skilled nursing care, hospice, and some home health care.‍
   • Part B: Covers doctor services, outpatient care, durable medical equipment, and preventive services.
   • Part C: Medicare Advantage Plans, offered by private companies, include all Part A and B benefits, often with added prescription drug coverage (Part D). ‍
   • Part D: Provides prescription drug coverage through private insurers.
2. Funding : Paid through payroll taxes, beneficiary premiums, and federal revenue.
3. Enrollment: Begins three months before turning 65 and ends three months after. Annual enrollment is also available for Medicare Advantage and Part D.
4. Administration: Managed by the Centers for Medicare & Medicaid Services (CMS).
5. Supplemental Coverage: Medigap policies can be purchased to cover costs not fully paid by Medicare.

Medicare Coverage for People with Disabilities

Medicare is available for individuals under 65 with disabilities who either receive Social Security Disability benefits for 24 months, or have End Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS). Those with ESRD are eligible after 3 months of dialysis or a kidney transplant, while those with ALS are eligible immediately upon starting Social Security Disability benefits.

Enrollment:

• Social Security Disability beneficiaries typically receive a Medicare card automatically. If not, contact the local Social Security office.
• Medicare coverage includes hospital, nursing home, home health, and physician services. Coverage is the same for those with disabilities as for those aged 65 and older.

Coverage for Long-Term Conditions:

• Medicare should not deny coverage based on long-term or chronic conditions like Alzheimer's, mental illness, multiple sclerosis, or Parkinson’s. Coverage is available even for maintenance-only services.

Medicare for Working People with Disabilities:

1. Coverage Components:
   
   • Allows individuals to work for up to 9 months while receiving Medicare and Social Security benefits. Earnings thresholds apply.
2. Extended Period of Eligibility (EPE):
   • After the TWP, individuals can receive Medicare for up to 93 months if their earnings meet the "Substantial Gainful Activity" level. Part A remains premium-free, but Part B requires payment.
3. Indefinite Access to Medicare:
   • After 93 months, Medicare continues as long as the individual remains disabled. Both Part A and Part B premiums are due. Low-income individuals may qualify for state assistance programs.

For more information or help with Medicare, contact us.

Do you need help applying for Medicare?

Would you like to know how to sign up for a Medicare plan and to understand which plan best fits your needs? As your personal agent, we will help you enroll and assist you with any questions you may have. Call us today at 864-507-5022