Learn About Medicare and the Requirements to Get Covered

Updated on 08/29/2022

Many patients receive their insurance because of the Affordable Care Act (ACA), also known as Obamacare. One of the most important parts of the ACA is the Medicare program. While Medicare is very helpful, it can also be a confusing program, because it is divided into separate parts. Medicare Parts A and B are funded by the federal government, while Medicare Parts C and D are offered through private insurance plans. The types of services covered, as well as the costs for insurance, all vary depending on the plan. Make sure you learn more about what Medicare coverage is available to you. More information regarding Medicare is covered in the following subjects:

• Who is eligible for Medicare coverage?
• What does Medicare cover?

Who can qualify for Medicare coverage?

There are eligibility requirements for Medicare coverage that people must meet. In order to receive benefits, applicants must either be legal U.S. citizens or have been legal permanent residents for at least five continuous years. Applicants must be eligible for Social Security benefits if they want access to Medicare benefits. Usually, applicants receive these benefits because of their age, but anyone receiving disability benefits for two consecutive years may also be considered eligible. For the purpose of determining eligibility, applicants with Railroad Retirement benefits are considered to have Social Security benefits. Applicants with serious medical disabilities may automatically be enrolled for Medicare coverage, even if they are not actively receiving Social Security benefits.

What does Medicare cover?

Anyone applying for Medicare coverage should look over all the different plans to find which ones are best for them in the state they live in. Each Medicare plan has different costs, premiums, deductibles, and co-pays. The most common type of Medicare coverage is Medicare Part A. Part A coverage is available to applicants who worked a job for at least 10 years where he or she had to pay Medicare taxes. The years do not have to be consecutive or from the same employer. Applicants who meet this qualification do not have to pay anything for Medicare Part A coverage.

Medicare Part A primarily covers hospital insurance, which includes costs for inpatient hospital care, some home health services and the cost of nursing facilities or hospice care. Medicare Part A also covers the cost of doctor-recommended services, such as physical or occupational therapy. Medicare Part B offers some of the same services as Part A, but it also covers general doctor visits and not just hospital services. For example, Medicare Part B covers the cost of physical exams, medical screenings and medical shots.

Medicare Part C is one of the more confusing plans. Medicare Part C covers the combined services of Medicare Part A and B, but it comes from a private insurance provider and not from the state. For some applicants, this may be a very important distinction. Private insurance providers have much more freedom in how their plans are customized, including the costs of the plans. Applicants that are not eligible for state discounts may benefit more from private insurance plans. In addition, private insurance plans allow for additional coverage, such as dental or vision plans. Whether or not Medicare Part C is better than Part A or B varies on a case-by-case basis, depending on the personal and financial situations of the applicant.

Medicare Part D covers the cost of prescription drugs. The payment plans for Medicare Part D work a little differently than other plans, since it uses a coverage gap instead of traditional payment options. The coverage gap is a certain amount that beneficiaries must pay out-of-pocket before the coverage from Medicare Part D begins.