Does Everyone Have To Enroll In Medicare?
” The answer is: “After a certain age.” For most people, that age is 65.
Medicare is divided into two parts, called Part A and Part B. Part A covers hospital and other inpatient care. Part B covers outpatient care, such as visits to your doctor's office, lab tests, x-rays, and other procedures.
Medicare Part A is generally paid for by a tax that is withheld from the Social Security checks of most people who work. If you're self-employed, you may be able to pay Part A from your own pocket. If you're still working after age 65, you'll likely have to continue to pay this tax from your own pocket, even though you won't be using Part A for yourself.
Medicare Part B is not deducted from your Social Security checks. Instead, it is paid from a “premium,” which is a yearly fee that you and your employer (if you still have a job) must pay in full, or in part. However, if you or your spouse worked and paid into the Social Security system for at least 10 years and, while working, paid taxes for at least 25 years, or if you are 65 or older and have held a government job or worked for public schools, you are also eligible to have your Part B premium paid by the government (although you can still choose to pay for it yourself, if you prefer).
As noted, Parts A and B of Medicare are divided up into four “coverage periods”:
Coverage Period 1: When you first start receiving your payments from Social Security (usually at age 62 or soon thereafter), you are eligible to receive Part A as well.
Coverage Period 2: When you become eligible to receive your first Social Security check (which is usually at age 65), you are also eligible to receive Part B.
Coverage Periods 3 and 4: Once you're eligible for Part B, you continue to have the option of purchasing those optional types of coverage.
When you first receive your first Social Security check and pay your Part B premium, you will receive a card that you should keep, and you should also receive a booklet that describes all the various Medicare options that you have and how to choose among them.
Obtaining Medicare coverage usually costs significantly more than just receiving the Social Security checks that you are receiving during your initial coverage period (Coverage Period 1).
The first time you receive Medicare, you will pay a premium for Part B (but not Part A). The amount of this premium will depend on how much you have earned in your lifetime. (Your premiums will also be affected by income that your spouse has earned.) The premium can be paid by your employer, if you have a job. If you are retired, you can pay the premium yourself. The higher your income, the higher your premiums will be. (For more details about these premiums, see Chapter 7.)
If you have a “limited income,” you might be eligible to receive your premiums for Part B and Part D, and possibly Part A, from the government, which will pay them directly to the insurance companies or to Medicare itself.
If you are eligible to receive your Part B premium from the government, you will still have to pay for your Part D premium, as well as any deductibles and co-payments, out of your own pocket.
If you have a “limited income,” you might also be eligible to receive a subsidy for your hospital insurance (Part A) premium. These subsidies are provided on a sliding scale, depending on how much your income is.
Note: If your income is more than the amount necessary to qualify for the subsidy, then you're not eligible for this government subsidy.
The Part A premium, if you make the choice to have it paid by the government, is a little less than the standard premium. As with the other Medicare premium, you can pay it yourself and get a rebate from the government.
medicare and the Affordable Care Act
The Affordable Care Act (ACA) has had a dramatic impact on the Medicare program.
The ACA created a new category of health care coverage, called “Medicare Advantage plans,” which essentially replaces Medicare Part C.
Starting in 2014, the Medicare Advantage plans must be “network providers,” which means they must work with an approved network of physicians and hospitals.
Starting in 2015, the government is no longer allowed to pay any extra money to Medicare Advantage plans that cover non-emergency transportation to and from medical visits.
In addition, if you are eligible for Medicare but you decide to enroll in a Medicare Advantage plan instead, you will not be able to re-enroll in Medicare for a year.
medicare and medicaid
In 1965, when Medicare was created, the actual medical insurance plans were created by the government. They were called “Fee-For-Service” plans.
However, by the late 1980s, there were serious problems with these government-run medical insurance plans. They were overcharging patients, and patients were not happy about it.
At that point, the government decided to open up the Medicare medical insurance market, so that other companies could compete with the government-run Fee-For-Service plans.
Today, Medicare works like any other insurance program. There are government-run plans and private plans, and you can choose which plan you want to be in.
In addition to the Medicare plans that the government runs and the Medicare Advantage plans that other companies run, there is a third type of medical insurance that you can purchase through Medicare: the Medicare Supplemental Plan, Part C.
This plan is basically a private medical insurance plan. It is similar to the Medicare Advantage plans, in that it is run by an insurance company