Immigrating to the USA is a long and tedious process, but once it’s behind you, there are many opportunities that can open up for you. Once you are settled, one of the first things that many people care about squaring away is health insurance.
If not yet retired or over age 65, lawfully present immigrants can get health insurance coverage through an employer. If not employed or if self-employed, coverage can be obtained through the Healthcare Exchange.
However, older people in America are usually covered through Medicare, which is a federal program that provides hospital, outpatient and drug coverage to people aged 65 and certain younger people with disabilities or End Stage Renal Disease. This program was created in 1965 and has acted as a safety net for decades so that seniors would be able to retire without fear of losing access to quality healthcare.
Permanent Residents and U.S. citizens are eligible for Medicare once they have lived in the United States continuously for 5 years. Let’s review how to qualify and apply for Medicare and what the costs and coverage are for the various parts.
Signing Up for Medicare
Legal permanent residents and U.S. citizens who are 65 or older will usually qualify for Medicare.
One of the criteria for being eligible for Medicare is that you or your spouse must have worked here in America and via that work, paid taxes into our Medicare system for 10 years (40 quarters). However, if you or your spouse do not have these work quarters, you may be able to purchase Medicare as long as you have lived constantly in America for 5 full years.
The place to apply for Original Medicare Parts A and B is down at your local Social Security office. You can reach Social Security at 1-800-772-1213.
To check your eligibility for Medicare before you apply, you can use this online eligibility tool.
What Medicare Costs
Medicare Part A costs nothing if you or your spouse have worked the necessary 40 quarters and paid taxes toward Medicare. Otherwise, Part A has a premium of $437/month. If you have worked at least 30 quarters, Part A will be pro-rated at $240/month in 2019.
The other parts of Medicare carry monthly premiums that all Medicare beneficiaries must pay. Part B has a standard base premium of $135.50/month for most people. High-income individuals will pay more for Parts B and D though based on their modified adjusted household gross income. This affects individuals who earn more than $85,000 or couples who earned more than $170,000 in the year two years prior to the current year. Individuals in these higher income brackets pay substantially more for Medicare.
Part D plan premiums vary based on the plan that you enroll in. These plans are purchased from individual insurance companies who offer them.
What Medicare Covers
Part A pays for hospital expenses. This includes inpatient stays as well as stays in a skilled nursing facility to recover after a hospital stay. Part A also pays for blood transfusions and hospice benefits.
Part B pays for outpatient medical services and pretty much anything else that is medically necessary. This includes visits to your physician, blood work, CT scans (and other imaging), ambulance, urgent care, emergency care, durable medical equipment, physical therapy, surgeries performed on an outpatient basis, and cancer treatment such radiation or chemotherapy. Part B also pays for drugs that are administered to you by a physician in a clinical setting.
Most individuals also sign up for Medicare Part D, which pays for your outpatient prescription medications. Although Part D is voluntary, if you don’t enroll when you are first eligible, you could face penalties later on when you do enroll.
Medicare pays for only about 80% of our healthcare expenses, so many people enroll in supplemental coverage to help pay for the deductibles, copayments and coinsurance that Medicare doesn’t pay for.
There are both Medicare Supplements and Medicare Advantage plans to choose from. Medicare Supplements, also called Medigap plans, are supplemental policies that pay after Medicare. There are several different plans to choose from ranging from a plan that covers all of the gaps and some that cover less for lower premiums.
Medicare Advantage plans are network-based policies sold by private insurance companies. You can opt to get your Medicare Part A, B, and D benefits through these plans instead of through Original Medicare. They typically have lower premiums up front, and instead, you’ll pay your share of healthcare services as you receive them.
To read more about how these types of coverage work, you can visit this page.