Health insurance is often described as complicated because of the different programs and plan types offered by organizations. The available health insurance plans include offers by private firms in line with established guidelines and programs. Medicare, a federal program, is covered in this piece.
Medicare is one of the federal health insurance programs available to persons that meet certain qualifying criteria. Medicare is available to persons that are at least 65 years old. Persons with disabilities can also benefit from this insurance program, as well as persons with end-stage diseases such as end-stage renal disease and require dialysis or a kidney transplant.
Because Medicare is only available to persons that qualify, access is not automatic for everyone and eligible parties may have to register. If you qualify for Medicare based on your age, you can register a few months before your 65th birthday. For persons with disabilities, registration can begin after 24 months of living with the disability. Apart from the age and disability criteria, it is noteworthy that Medicare applicants must have lived in the US for at least 5 years. They must also be legal residents of the US.
Medicare plans are available in different forms, as original Medicare as well as Medicare Advantage plans and prescriptions plans, designated as parts A, B, C, and D.
Part A of Medicare is part of original Medicare which comes at no cost for persons that paid for it during their working years or the working years of their spouse. Part B of Medicare requires a premium and is also part of the original Medicare. Part C is otherwise known as the Medicare Advantage Plan and is offered by private firms and is inclusive of parts A ,B and sometimes D. Part D is the prescription drug plan that can cover Rx costs not covered by original Medicare.
Registering for Medicare
If you are eligible for Medicare based on your age, you become eligible to enroll three months before your 65th birthday. The initial enrolment period extends from three months before the 65th birthday of the enrollee, includes the birthday month and extends to three months after the birth month.
The initial enrolment means signing up for parts A and B. Part A is usually free because a lot of enrollees and/or their spouses pay into the fund during their working years. Part B, on the other hand, requires a premium, unless you qualify for help through the state Medicaid program.
When signing up for Medicare, you get the basic A & B plan coverage. However, these plans leave sizeable expenses uncovered. Costs uncovered by Original Medicare can be covered by other plans such as the Medicare part D plan, Part C Advantage plan and a Medigap policy.
Apart from the initial period when you become eligible for Medicare, you can register for plans during the open enrolment periods every year. The first open enrolment period is between October 15 and December 7 every year, for plans that will be effective from the first of January of the next year. During this period, changes can be made to Part D Medicare plans as well as Medicare Advantage Plans.
The second open enrolment period applies to beneficiaries of Medicare Advantage plans. From January 1 to March 31, beneficiaries can switch to the original Medicare plan or change their Medicare Advantage Plan to another Advantage plan.
Based on certain criteria, one can also qualify for a special enrolment period (SEP). Moving to another county, losing group or union coverage and your current plan leaving your service area are all reasons that you may qualify for an SEP. During a SEP you will have a period of time (usually 2-3 months) to pick a new plan.
History of Medicare
Medicare was created because of the lack of proper health insurance for persons that are 65 years old and above, as well as persons with disabilities. These categories of persons struggled to find proper insurance plans offered by private firms. Often if coverage was found it was priced well outside of the average retired workers budget.
The move for universal and easy access to healthcare began in the early part of the 20th century when President Roosevelt, whose campaign weighed focused majorly on healthcare, began national discussions in that direction. Although President Roosevelt’s administration achieved little in that regard, a few decades later, President Truman continued in his steps in the 1940s. The efforts of President Truman were also successful but paved the way for President Kennedy to push for national health insurance for senior citizens. The efforts of President Kennedy was also unsuccessful, but in 1966, after President Johnson signed the bill into law in 1965, Medicare became available. About 16 million senior citizens signed up for Medicare in 1966. Over the years, the coverage of Medicare has grown with about 60 million persons benefiting from the program at the beginning of 2019.
The transitioning of Medicare
From the 1960s to date, several changes have been made to Medicare to achieve the multi-faceted aims of the programs. These changes include the inclusion of persons with end-stage kidney diseases as well as ALS patients that are younger than 65. Medigap and Medicaid are other modifications of Medicare, extending the reach of the program and improving access to healthcare. With the Patient Protection and Affordable Care Act of 2010, Medicare was modified in several ways, towards improved affordability and accessibility.
Medicare Changes in 2020
In line with the overall goals of Medicare, certain changes will be implemented in 2020. An important change that began in January 2020, the inaccessibility of plans C and F by newly-registered beneficiaries of Medicare.
From January 2020, Medicare plan B has been imposed on new beneficiaries. However, old beneficiaries can continue to benefit from the plans.
The elimination of the doughnut hole for generic drugs is another major Medicare change that will occur soon. The doughnut hole will be changed in that the cost of drugs before and during the doughnut hole will change. This change which has been effected for prescription drugs in 2019 will have the part D plan covering most of the cost of drugs before the doughnut hole and the manufacturers covering more of the cost in the doughnut hole. The maximum amount payable for drugs should be eliminated soon as well.
In 2020, the basic premium for the part B plan increased, from $135.50 to $144.60 per month. However, adjustments were made to cover the difference. Premiums have also been adjusted according to the income of enrollees. Most seniors pay the basic part B premium, but higher income persons pay an increased rate. The chart at this link shows the rates for Part B based on income. The cut-off for high-income enrollees was adjusted according to inflation as well. In 2020 and beyond, Medicare is poised towards accessibility and is bound to cater to an increasing population of beneficiaries. If you want help navigating your Medicare options Indyhealthagent.com is just a phone call or click away offering no-cost assistance.