Medicare Explained

Medicare is a federal health insurance program broken up into individual parts, each plan with its own benefits. Medicare eligibility is also limited to certain factors. Let’s breakdown the basics of Medicare you should know.

Coverage Provided By These Plans

Original Medicare coverage can be broken down by its two individual parts. Under Part A, you receive hospital care up to 60 days and nursing facility care up to 20 days. Generally, then, it covers emergency care.

Part B, on the other hand, covers (to some extent) most any service deemed “medically necessary” by your doctor. Compared to their costs, both Parts A and B offer great coverage.

Medicare Advantage combines all the benefits of Original Medicare and lowers your overall out-of-pocket costs. Think of it as an “all-in-one” alternative to Parts A and B, working to provide immediate doctoral care at less of a price.

Medicare supplements cover a lot of the out-of-pocket costs that come up in Original Medicare. While Advantage lowers the cost of services already provided by Parts A and B, supplements add additional cost coverage for things like your premiums, deductibles, and more.

Medicare Eligibility

Original Medicare eligibility is restricted to:

  • Those 65 or Older
  • Those with End-Stage Renal Disease (ESRD)
  • Those Who Have Received 24 Months or More of Social Security Disability Payments.

However, this is specifically for Original Medicare. Once you have signed up for both Parts A and B, you have many plan options to add to or replace with your Original Medicare.

This includes Parts C, D, and supplements. Each of these additional parts has their own specific eligibility requirements:

  • Medicare Advantage:
    • HMO: You must have Original Medicare to enroll in an HMO.
    • PPO: You also must have Original Medicare to enroll in a PPO.
    • PFFS: The same requirement for HMO and PPO applies to PFFS plans.
    • D-SNP: You must have both Original Medicare and Medicaid for an Advantage D-SNP.
    • C-SNP: You must have a qualifying chronic condition for a C-SNP.
  • Part D: You are only required to have Original Medicare for Part D eligibility. You can also enroll in an Advantage plan with Part D, but not a supplement plan.
  • Medicare Supplements: As long as you’re signed up for Original Medicare, you are eligible for any supplement plans within the 6 months following your 65th birthday. However, after these 6 months, you can become ineligible based on health.

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If you’re interested in Medicare, you’ve come to the best place in Missouri. InvoBH has the expertise you need to feel confident in your health insurance. When you’re ready to get started, give us a call at 314-669-4308.