What are the Medicare Rules?

Medicare is a health insurance program offered by the federal government of the United States. Medicare formerly consisted of only two parts, A and B. As of 2011, Medicare officially falls into four parts to include private Medicare advantage plans and prescription drug plans. Several Medicare Supplement Plans include standardized benefits, but are sold through insurance companies. Medicare does not come without rules and restrictions, however, even if you have purchased it privately.


Medicare is for people 65 and older, although there are some exceptions. To qualify initially for Medicare, you must generally meet the minimum age and be a United States citizen or permanent resident. You and/or your spouse must also have had a job paying Medicare taxes for at least 10 years. If you have not done this but are of 65 years or older, you may still be eligible for Medicare Part A if you pay a monthly premium. People under the age of 65 may also be entitled to Medicare Part A if they have end-stage renal failure, or if they have already been receiving Railroad Retirement Board or Social Security benefits.

Medicare Part A may be premium free if it meets certain conditions. Part B, however, must be paid. As of 2011, the Part B premium is officially $110.50 per month. The citizens who have started coverage as of January 1, 2010 or those with higher income, pay this amount. However, if you signed up before January 1, 2010 and the Part B premium is deducted directly from your Social Security benefits, you will continue to pay $96.40 per month.


Medicare Parts A and B offer benefits for inpatient and outpatient hospitalizations, preventive services, health screenings, home health care and hospice, however, they offer no benefit to dental care, prescription drugs, eye checkup, eyeglasses or travel emergency abroad. For these benefits, you will either have to purchase either a Medicare Advantage Policy, an independent Medicare Part D prescription drug plan, or one of the standardized Medicare Supplement Plans.

People who are already receiving Social Security benefits are automatically enrolled in Medicare when they turn 65. If you are not yet receiving Social Security benefits, you will need to sign up. You can apply online or at a local Social Security office three months before your 65th birthday. Your initial enrollment period covers three months before your birthday and three months after the month of your birthday. You can enroll in any Medicare coverage you want during the initial enrollment. If you do not enroll in Part B or Part D when you are first eligible, you may have to pay higher rates in the future.

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