MEDICARE

Who is eligible?

US citizens or permanent residents over the age of 65, eligible for Social Security benefits after 10 years of work, and 40 credits, are automatically entitled to Medicare Part A and B or original Medicare.

What does Original Medicare cover?

Part A: Hospital.

Skilled nursing facility

Intensive care

Operating room and recovery room services.

Rehabilitation and physical therapy.

Home health care.

Among other services.

Part B: Doctors.

Coverage of 80%.

Also includes other medical supplies and preventive services.

What is the Medicare Advantage or Part C?

People who have already acquired their Original Medicare (Parts A and B) can enroll in Medicare Part C (except for patients with End-Stage Renal Disease ESRD).

Counties offer a variety of Medicare Advantage HMO (Health Maintenance Organization) and PPO (Preferred Provider Organization) plans. They offer benefits outside of Original Medicare adding vision, dental, hearing, gym membership, OTC (over-the-counter medication), and more.

Other Medicare Advantage plans are designed for dual eligibility individuals, that is, those with both Medicare and Medicaid, in which case payment of the Part B premium by the beneficiary is suspended.

What is Part D?

It is the part corresponding to Prescription Drugs to help pay for this concept.

When to apply for Medicare Advantage?

Annual Enrollment Period (AEP): From October 15th to December 7th, with an effective date of the following January 1st. During this period the beneficiary can enroll in a plan for the first time or change to another available in their county of residence.

Open Enrollment Period (OEP): From January 1st to March 31st and make changes to plan effective the 1st of the following month.

Initial Enrollment Period (IEP): Begins 3 months before and 3 months after the effective date of the Original Medicare.

Special Enrollment Period (SEP): It is an enrollment opportunity for people who experience some change in eligibility such as moving, acquiring Medicaid, among other changes.