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How Medicare Works?
The Eligibility Requirements for Medicare:-
Eligibility requirements for Medicare are a complex topic. It is important to know that each individual’s case is different. However, everyone must meet some general qualifications to be eligible for Medicare. These include:
– Being a U.S. citizen or permanent resident
– Being at least 65 years old
– Living in the U.S. and being a permanent resident for at least five years – Receiving Social Security benefits or Railroad Retirement benefits
– Not being enrolled in another health care plan (for example, an employer plan) that can provide coverage comparable to Medicare.
– Not having any other source of health insurance other than Medicare
There are also some qualifications specific to the individual. These include:- Having a disability that was certified by the Social Security Administration.
History of Medicare
The U.S. government introduced Medicare in 1965 as a social insurance program. It was designed to provide health coverage for older people, people with disabilities. Medicare is funded by a payroll tax of 2.9% that employers and employees pay on earnings, half paid by the employer and half paid by the employee…
Learning About Medicare Plans
Get started with Medicare
Medicare is health insurance for people 65 or older. You’re first eligible to sign up for Medicare 3 months before you turn 65. You may be eligible to get Medicare earlier if you have a disability, End-Stage Renal Disease (ESRD), or ALS (also called Lou Gehrig’s disease).
How Medicare works with other insurance
If you have Medicare and other health insurance (like from a group health plan, retiree coverage, or Medicaid), each type of coverage is called a "payer." When there's more than one payer, "coordination of benefits" rules decide who pays first. The "primary payer" pays what it owes on your bills first, and then sends the rest to the "secondary payer" (supplemental payer) to pay. In some rare cases, there may also be a third payer.
What it means to pay primary/secondary
The insurance that pays first (primary payer) pays up to the limits of its coverage.
The one that pays second (secondary payer) only pays if there are costs the primary insurer didn't cover.
The secondary payer (which may be Medicare) may not pay all the remaining costs.
If your group health plan or retiree coverage is the secondary payer, you may need to enroll in Medicare Part B before they'll pay.
If the insurance company doesn't pay the claim promptly (usually within 120 days), your doctor or other provider may bill Medicare. Medicare may make a conditional payment to pay the bill, and then later recover any payments the primary payer should've made.