TalkingMedicare

TalkingMedicare

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Original Medicare

Original Medicare is somewhat automatic when a person reaches the age of 65, but not in all cases. Let's explore.

Original Medicare is somewhat automatic when a person reaches the age of 65. There are qualifications that need to met like being a US citizen or a permanent resident meeting minimal work history requirements.

Original Medicare consists of Part A

and Part B.

Each of these parts has its own characteristics and coverages.

Part A basically covers Hospital, skilled nursing facility, hospice, and home health services.

Part B basically covers Professional services such as those provided by a doctor or non-physician professional, outpatient care, and other medical services.

Medicare coverage is based on 3 main factors:

  1. Federal and state laws.
  2. National coverage decisions made by Medicare (CMS) about whether something is covered.
  3. Local coverage decisions made by companies in each state that process claims for Medicare. These companies decide whether something is medically necessary and should be covered in their area.

As you approach the age of 65, whether you have retired and gone on Social Security or not, you may automatically be enrolled in Part A, assuming you meet the citizenship / permanent resident requirements. I'll talk about the specifics of those requirements and the cost of the coverage in a future post.

Part B is also semi-automatically tied to you reaching the age of 65. You will have the option of taking the Part B coverage at it's first availability or waiting to a future time. If you decide to delay enrollment there may be penalties associated with enrollment depending on the reasons for the delay. Again I'll get into those specifics in later posts.

At the same time you are faced with these Medicare choices you are probably also in the midst or approaching the time when you have to make financial decisions about what you are going to do about Social Security retirement benefits - that's another whole detailed, complex discussion. For couples it won't be any easier because all of these decisions are per person although they usually have to be considered by the couple in a co-ordinated process so they have the best combination that works for them as a couple.

Unfortunately Original Medicare is not the only way you can get your health care coverage - that's where the Advantage plans, Drug coverage plans and Medigap / Supplemental coverage choices come into play.

The matrix of choices has begun but you should review them each year - forever!