Medicare Insurance plans can be challenging to understand. The purpose of this page is to help explain and simplify the answers to common questions related to Medicare Insurance plans.

Simply put, Medicare Insurance plans is a federal health insurance program for people in the U.S. who are 65 and older. Medicare also provides coverage for some younger people with disabilities. Medicare differs from Medicaid, which offers health coverage and services to eligible low-income families, regardless of age.

Any U.S. citizen (or permanent legal resident for the past five years) 65 years or older qualifies for Medicare coverage in Englewood, FL. Disabled persons under the age of 65 may also qualify for Medicare. Disabled persons under age 65 become eligible after receiving Social Security disability insurance and then after a two-year waiting period. Some exceptions exist for late stage diseases such that people with these conditions can qualify immediately.

Upon turning 65, people already receiving Social Security benefits are enrolled automatically in Medicare Part A and Part B, but must enroll manually in Part D. For someone not already receiving Social Security benefits, you can sign up directly through the Social Security Administration website. In most cases, sign up should occur within a period stretching 3 months before the month you turn 65 to 3 months after the month you turn 65. Enrollment outside of this period may result in penalties. Enrollment for supplemental coverage occurs during the same window, otherwise enrollment may be denied.

Medicare participants do not pay premiums for Medicare Part A as long as the participant or spouse worked and paid Medicare taxes for at least 10 years (40 quarters). The Medicare tax is typically coming out of workers’ paychecks automatically. If you have any questions about whether or not you qualify for premium-free Part A, reach out to the Social Security Administration. Even if you don’t qualify for premium-free Part A, some people are eligible to buy in to Part A for premiums of up to $437 per month. Medicare Part B requires monthly premiums from participants and can vary based on income.

In general, Medicare Part A covers hospital care, such as the following:

• Inpatient care in a hospital
• Skilled nursing facility care
• Inpatient care in a skilled nursing facility (not custodial or long-term care)
• Hospice care
• Home health care.

Part B covers two types of services. First, medically necessary services. These are services or supplies needed to diagnose or treat your medical condition and that meet accepted standards of medical practice. Second, Part B covers preventive services, such as flu shots, etc. Most preventive services do not cost anything as long as the provider accepts Medicare Part B. in general Medicare Part B covers the following:

• Clinical research
• Ambulance services
• Durable medical equipment (DME)
• Mental health – inpatient, outpatient, partial hospitalization
• Getting a second opinion before surgery
• Limited outpatient prescription drugs

Medicare does not cover the costs associated with deductibles and co-pays for the covered services. Some of the items and services that Medicare does not cover include the following:

• Long-term care
• Most dental care
• Eye exams related to prescribing glasses
• Dentures
• Cosmetic surgery
• Acupuncture
• Hearing aids and exams for fitting them
• Routine foot care