Medicare Eligibility and Enrollment: The Basics |

Medicare Eligibility and Enrollment: The Basics 

Who’s eligible for Medicare? 

Most people qualify for all Medicare programs if they’re 65 or older and are citizens or permanent residents of the United States. Also, people under 65 who are disabled or have end-stage renal disease can also qualify for Medicare. In those cases, it is provided after diagnosis. 

How does someone enroll in Medicare? 

People who are receiving any type of Social Security benefits when they turn 65 will be automatically enrolled in Medicare, and will receive enrollment cards and information about three months before their 65th birthday. If they aren’t automatically enrolled, they may sign up at any local Social Security office. They should enroll two or three months before they turn 65 to ensure prompt coverage. 

Which health care providers can Medicare patients see? 

Medicare patients can go to any doctor, hospital, clinic, outpatient provider, nursing facility, home care agency or pharmacy approved by Medicare and that accepts Medicare patients. Before a visit, it’s essential to verify that the doctor or other provider accepts Medicare. 

What does Medicare cover? 

Medicare is intended primarily to provide coverage if and when someone becomes ill or injured. This includes hospitalization, doctors’ services, lab work, X-rays, hospice and just about every kind of outpatient care, as well as some inpatient nursing facilities and both inpatient and outpatient mental health care. 

Over the years, however, Medicare has evolved to also cover a range of preventive and screening services. Some of these services include cardiovascular screening; smoking cessation counseling; screening for breast, cervical, vaginal, colon and prostate cancers; immunizations for flu, pneumococcal virus and hepatitis B; diabetes screening and supplies; glaucoma tests; and a “Welcome to Medicare” physical exam. 

For those who meet certain requirements for home health care, Medicare also pays for part-time nursing care; part-time health aides; speech, physical and occupational therapy; and medical supplies and equipment such as bandages and wheelchairs. 

What’s not covered by Medicare? 

Medicare isn’t intended or designed to provide long-term nursing home or in-home care, so there are significant gaps in these areas. Families can’t rely on Medicare to pay for 24-hour at-home care, meals, delivery services or many of the personal services provided by home health aides (except for some skilled nursing care for a short time if it’s medically necessary). 

Although Medicare has added many preventive services to its coverage in recent years, many such routine care needs are not yet covered, including dental care and dentures, medical treatment outside the United States, routine physical exams, glasses and hearing aids, and long-term care. Additionally, Medicare doesn’t cover elective procedures, including cosmetic surgery, massage therapy, and acupuncture. 

When seeking medical care, ensure the doctors you have in mind accept Medicare, or the program won’t pay for even covered costs. This is also true for outpatient care, home care and prescription drugs, which Medicare patients must buy from a pharmacy that participates in their particular plan. 

How much does Medicare cost? 

Each part of Medicare has a different payment system. And within each part, patients’ out-of-pocket costs will depend on the particular way they receive their benefits. 

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