Medicare Information

  • Medicare is the Federal Government program that provides health insurance coverage if you are 65 years old, or under 65 and receiving Social Security Disability Insurance (SSDI) for a certain amount of time. The Centers for Medicare & Medicaid Services (CMS) is the federal agency that runs Medicare. The program is funded in part by Social Security and Medicare taxes you pay on your income, in part through premiums that people with Medicare pay, and in part by the federal budget.

  • Once you have become Medicare-eligible and enroll, you can choose to get your Medicare benefits from Original Medicare, the traditional fee-for-service program offered directly through the federal government, or from a Medicare Advantage Plan, a type of private insurance offered by companies that contract with Medicare (the federal government). 

    • Original Medicare includes:

      • Part A (Inpatient/hospital coverage)

      • Part B (Outpatient/medical coverage)

  • If you want Medicare prescription drug coverage (Part D) with Original Medicare, in most cases you will need to actively choose and join a stand-alone Medicare private drug plan (PDP).

  • You still have Medicare if you enroll in a Medicare Advantage Plan. This means that you will still owe a monthly Part B premium. Each Medicare Advantage Plan must provide all Part A and Part B services covered by Original Medicare, but can do so with different rules, costs, and restrictions that can affect how and when you receive care. Medicare Advantage Plans can also provide Part D coverage.  You have the choice to stay with this plan, switch to Original Medicare, or enroll in a different Medicare Advantage Plan.

  • It is important to understand your Medicare coverage choices and to pick your coverage carefully. How you choose to get your benefits and who you get them from can affect your out-of-pocket costs and where you can get your care. For instance, in Original Medicare, you are covered to go to nearly all doctors and hospitals in the country. Medicare Advantage Plans, on the other hand, usually have network restrictions, meaning that you will be more limited in your access to doctors and hospitals. However, Medicare Advantage Plans can also provide additional benefits that Original Medicare does not cover, such as routine vision, dental, transportation, over the counter benefits, Part D Rx, and more!

  • Medicare is different from Medicaid, which is another Government program that provides health insurance. Medicaid is funded and run by the federal government in partnership with states to cover people with limited incomes. Remember, unlike Medicaid, Medicare eligibility does not depend on income, everyone over 65 is automatically enrolled into Medicare. Also, eligible individuals can have both Medicare and Medicaid and are known as dual-eligibles. Everything is no cost, even copays, co-insurance, and deductibles. 

  • Everyone who has Medicare receives a red, white, and blue Original Medicare card. If you choose to receive your coverage through Original Medicare, you will show this card when you get services. If you choose to receive your Medicare benefits through a Medicare Advantage Plan, you will still get an Original Medicare card but you will show your Medicare Advantage Plan card when you get services.

Medicare Growth Projection

  • Medicare spending is also projected to grow at a faster rate between 2018 and 2028 (5.1 percent) than between 2010 and 2018 (1.7 percent).

  • Every day in the U.S., 10,000 people turn 65, and the number of older adults will more than double over the next several decades to top 88 million people and represent over 20 percent of the population by 2050.

  • As a share of total Medicare benefit spending, payments to Medicare Advantage plans for Part A and Part B benefits increased by nearly 50 percent between 2008 and 2018, from 21 percent ($99 billion) to 32 percent ($232 billion) of total spending, as enrollment in Medicare Advantage plans increased over these years.

  • Individuals receiving Social Security Disability income for 2 years will receive Medicare, there are 13,790,000 people in the United States currently on SSDI. This market has a projected growth of 5% annually through 2028. 

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