Medicare: Legal Definition

Medicare is a federal health insurance program for older adults and the disabled.

During your working years, each time you receive a paycheck, a certain percentage gets automatically deducted, and this money funds Medicare. Medicare consists of hospital coverage, medical coverage, and prescription drug coverage.

Who Is Eligible for Medicare

Many people think of Medicare as a program for older adults. While older adults make up a large percentage of Medicare recipients, the program is actually available to three classes of people:

  • People 65 years old and older
  • People younger than 65 years old who have certain disabilities
  • People with end-stage renal disease (permanent kidney failure requiring dialysis)

What Are the Different Parts of Medicare?

Medicare is comprised of three types of coverage: Parts A, B, and D. Each part provides different benefits.

Medicare Part A

Medicare Part A offers hospital insurance. It covers hospital stays, nursing facilities, hospice care, and limited in-home care.

If you have worked and made sufficient payroll tax contributions, you generally do not have to pay a premium for Medicare Part A. You will start receiving it at age 65. If you receive Social Security Disability Insurance (SSDI), you qualify for Medicare after a 24-month waiting period.

Medicare Part B

Medicare Part B offers medical insurance. It covers doctor’s office visits, preventative services, and outpatient care.

Although most Medicare recipients are enrolled in both A and B, Part B is not automatic, nor is it required. It requires a monthly premium even if you have worked and paid payroll taxes. As of 2018, the standard Medicare Part B premium is $134 per month.

Medicare Part D

Medicare Part D covers prescription drugs. However, you cannot buy Medicare Part D directly through the government; you must go through a private insurance company.

You can also receive prescription drug coverage through certain Medicare Advantage plans. These are health insurance plans that reroute Medicare Part B through a private insurer. If you receive prescription drug coverage through a Medicare Advantage plan, it will follow the same rules as a standalone Part D plan offered by a private insurer.

Free Case Evaluation With a Disability Lawyer

If you need help with a Social Security disability application or appeal, the disability attorneys at the Disability Advantage Group, can help. We offer a free consultation and case evaluation. To speak with a member of our team today, call us at 865-566-0800.