What is Medicare?
Medicare is a federal health insurance program in the United States for individuals 65 years of age or older and for some younger individuals with disabilities. It covers a range of medical services, including hospital stays, doctor visits, and certain preventive services. Medicare is funded through payroll taxes and premiums paid by beneficiaries.
Who can get Medicare?
Medicare is available to the following individuals:
- Individuals who are 65 years of age or older, regardless of income or medical history
- Younger individuals with certain disabilities, such as end-stage renal disease or Lou Gehrig's disease
- Individuals with ALS (Amyotrophic lateral sclerosis)
Additionally, certain spouses and widows/widowers of individuals who have met the eligibility criteria may also be eligible for Medicare.
What is Medicare Part A?
Medicare Part A is one of four parts of Medicare. Part A covers inpatient hospital services, skilled nursing facility care, hospice care, and some home health care services. It is known as the "hospital insurance" part of Medicare, as it primarily covers costs associated with hospital stays. Part A is generally premium-free for most beneficiaries, as it is funded through payroll taxes paid by workers and their employers during their working years.
What is Medicare Part B?
Medicare Part B is one of four parts of Medicare. It covers medical services and supplies that are considered medically necessary to treat a disease or condition. Some of the services and supplies covered by Medicare Part B include doctor's services, outpatient hospital care, certain home health services, durable medical equipment, and some preventive services.
Part B is optional and requires the payment of a monthly premium. Beneficiaries may also be responsible for paying a deductible and coinsurance for some services. The cost of Part B is typically deducted from Social Security benefits.
What is Medicare Part D?
Medicare Part D is a federal program that provides prescription drug coverage to Medicare beneficiaries. It is an optional addition to Original Medicare (Parts A and B) and is offered by private insurance companies that have been approved by Medicare. Part D plans typically cover both generic and brand-name prescription drugs and may include a network of participating pharmacies.
Beneficiaries can enroll in a Medicare Part D plan during their Initial Enrollment Period or during the Annual Enrollment Period (October 15 - December 7). The cost of a Part D plan depends on the specific coverage and may include a monthly premium, annual deductible, and copayments or coinsurance for covered medications. The specific cost and coverage options will vary depending on the plan selected.
What is a Medicare Supplement Plan?
A Medicare Supplement Plan, also known as a Medigap plan, is a private health insurance plan that helps fill gaps in Original Medicare (Parts A and B). It helps pay for some of the out-of-pocket costs that Original Medicare does not cover, such as copayments, coinsurance, and deductibles.
Medicare Supplement Plans are standardized and are designated by letters A through N. Each letter plan provides a different level of coverage and the plans with higher letters generally offer more comprehensive coverage, but at a higher cost.
Medicare Supplement Plans can be purchased from private insurance companies, but the coverage and pricing are regulated by the federal government. Beneficiaries with Original Medicare can enroll in a Medicare Supplement Plan at any time, although enrolling during the open enrollment period, which begins the month you turn 65 and are enrolled in Medicare Part B, generally guarantees acceptance without a medical underwriting.
What is a Medicare Advantage Plan (Part C)?
Medicare Advantage Plan (Part C) is a type of Medicare health plan offered by private insurance companies that contract with Medicare to provide all Part A and Part B benefits and may provide prescription drug coverage (Part D) in one convenient plan. Medicare Advantage plans are an alternative to Original Medicare (Parts A and B).
Beneficiaries with Original Medicare can choose to enroll in a Medicare Advantage Plan instead of Original Medicare during the Annual Enrollment Period (October 15 - December 7). The cost of a Medicare Advantage Plan depends on the specific coverage and may include a monthly premium, copayments, and coinsurance for covered services.
It's important to note that Medicare Advantage plans have network restrictions and may require prior authorization and cost sharing for certain services, so beneficiaries should carefully consider their healthcare needs and choose a plan that best fits those needs.
What are my coverage options under Medicare?
Under Medicare, individuals have several coverage options, including:
- Original Medicare (Parts A and B): This is the traditional fee-for-service Medicare program that covers hospital (Part A) and medical (Part B) services.
- Medicare Supplement Plan (Medigap): This is a private insurance plan that helps fill gaps in Original Medicare coverage by covering some of the out-of-pocket costs, such as deductibles and copayments.
- Medicare Advantage Plan (Part C): This is a Medicare health plan offered by private insurance companies that provides all Part A and Part B benefits and may offer prescription drug coverage (Part D) in one convenient plan. Medicare Advantage plans may also offer additional benefits not covered by Original Medicare.
- Prescription Drug Coverage (Part D): This is a separate federal program that provides prescription drug coverage to beneficiaries enrolled in Original Medicare or a Medicare Supplement Plan.
It's important to review each coverage option and understand the costs, benefits, and restrictions to determine which option best fits your healthcare needs and budget. It is also advisable to consult with a Licensed Insurance Representative or visit Medicare.gov for more information.
What does Medicare cost?
The cost of Medicare depends on several factors, including the type of coverage you have and the specific services you receive. Some of the costs associated with Medicare include:
- Premiums: Most individuals with Medicare will pay a monthly premium for Part B and/or a prescription drug plan (Part D). The cost of the premium will vary depending on the specific plan.
- Deductibles: Some plans have an annual deductible, which is the amount you pay before your insurance starts covering costs.
- Coinsurance and copayments: Coinsurance is your share of the cost for covered services, while copayments are a set fee you pay for a specific service.
- Out-of-pocket expenses: Even with Medicare coverage, you may still be responsible for some of the costs associated with your healthcare, such as deductibles, coinsurance, and copayments.
- Late enrollment penalties: If you do not enroll in Part B or a prescription drug plan when you first become eligible, you may be subject to late enrollment penalties, which will increase your monthly premium.
It is important to note that the cost of Medicare coverage may change each year, so it is advisable to review your coverage and costs annually during the Annual Enrollment Period (October 15 - December 7). You can also consult with a Licensed Insurance Representative or visit Medicare.gov for more information on the specific costs associated with your Medicare coverage.
What is a copay?
A copayment, commonly referred to as a copay, is a fixed dollar amount that you pay out-of-pocket for a specific medical service or medication. A copay is typically a small, predetermined fee that you pay at the time of service or at the time of filling a prescription.
The amount of a copay can vary depending on the type of service or medication you receive, as well as your specific insurance plan. For example, a copay for a primary care visit may be different from a copay for a specialist visit. Some insurance plans also have different copays for generic and brand-name medications.
It's important to understand the copays associated with your insurance plan and to budget for these out-of-pocket costs when planning for your healthcare expenses. You should also check with your insurance provider for more information on your specific copays.
When can I initially enroll in Medicare?
You are initially eligible to enroll in Medicare when you turn 65 years old. Your initial enrollment period (IEP) begins three months before your 65th birthday month, includes your birthday month, and ends three months after your birthday month. During this seven-month period, you can enroll in Original Medicare (Parts A and B), a Medicare Advantage Plan (Part C), or a prescription drug plan (Part D).
If you are already receiving Social Security benefits when you turn 65, you will automatically be enrolled in Medicare Parts A and B. If you are not receiving Social Security benefits, you will need to take action to enroll in Medicare.
- If you are still working and have insurance from your employer, you may choose to delay enrolling in Medicare. You should check with your employer and consult with a licensed agent to determine your best course of action.
It's important to note that there are penalties for late enrollment in Medicare, so it's advisable to enroll during your IEP to avoid these penalties and ensure continuous coverage. You can enroll in Medicare through the Social Security Administration, or online at www.ssa.gov.
Can I enroll in Medicare due to a disability?
Yes, if you have a disability, you may be eligible for Medicare before age 65. If you have been receiving Social Security Disability Insurance (SSDI) benefits for at least 24 months, you will automatically be enrolled in Medicare Parts A and B.
If you have a qualifying disability, such as End-Stage Renal Disease (ESRD), you may be eligible for Medicare coverage regardless of your age. In these cases, you should contact the Social Security Administration (SSA) to learn more about your eligibility and how to enroll in Medicare.
- It's important to note that Medicare coverage based on a disability is different from Medicare coverage based on age, and the costs, benefits, and enrollment processes may vary. You should consult with a licensed agent or visit Medicare.gov for more information on Medicare eligibility and enrollment for individuals with disabilities.
When can I change my Medicare coverage?
You can change your Medicare coverage during certain times of the year. The Annual Enrollment Period (AEP) is the time when you can make changes to your Medicare coverage, including enrolling in a new Medicare Advantage Plan (Part C) or switching from one Medicare Advantage Plan to another, enrolling in a new prescription drug plan (Part D), or switching from a Medicare Supplement (Medigap) Plan.
The AEP runs from October 15 to December 7 each year. During this time, any changes you make to your Medicare coverage will take effect on January 1 of the following year.
If you have a special circumstance, such as moving out of your Medicare Advantage Plan's service area, you may be eligible for a Special Enrollment Period (SEP) to make changes to your Medicare coverage outside of the AEP.
It's important to review your Medicare coverage each year during the AEP to ensure that it continues to meet your needs and to make any necessary changes. You can also consult with a Licensed Insurance Representative or visit Medicare.gov for more information on changing your Medicare coverage.
What if I work past age 65?
If you are still working and have insurance from your employer when you turn 65, you may choose to delay enrolling in Medicare. In this case, you may continue to receive health insurance coverage from your employer and may not need to enroll in Medicare right away.
If you have health insurance through your employer and your employer has 20 or more employees, your employer insurance is considered the primary coverage and Medicare will be the secondary coverage.
If your employer has fewer than 20 employees, Medicare will be the primary coverage and your employer insurance will be secondary. In this case you will need to enroll in both Medicare Part A and Part B.
It's important to note that if you are still working and have insurance from your employer, you should contact your employer's benefits administrator or a licensed agent for more information on your options and to determine the best course of action for your individual circumstances.
Can I stay in an HSA after age 65?
Health Savings Accounts (HSAs) are savings accounts that are typically paired with a high-deductible health insurance plan and are designed to help individuals save money on health care expenses. If you are over 65, you can still contribute to an HSA, but you can no longer use HSA funds to pay for insurance premiums.
Once you enroll in Medicare, you are no longer eligible to contribute to an HSA, as Medicare is a form of health insurance that does not meet the requirements for an HSA-eligible high-deductible health plan. However, if you have funds in an HSA before enrolling in Medicare, you can still use those funds to pay for eligible health care expenses, such as deductibles, copays, and coinsurance.
If you have an HSA and are turning 65 or are enrolling in Medicare for the first time, it's important to understand how your HSA and Medicare coverage work together and to consult with a financial advisor or a licensed agent for more information on your options.
How do I choose what Medicare coverage is best for me?
Choosing the best Medicare coverage for your individual needs can be a complex decision, as there are many different options available and the costs, benefits, and restrictions of each option can vary. Here are a few steps you can take to help determine the best Medicare coverage for you:
- Review your current health needs and expenses: Consider your current health needs and the types of medical services and treatments you use regularly. Think about any medications you take and their cost, as well as any pre-existing conditions or chronic conditions you have.
- Evaluate your budget: Consider how much you can afford to spend each month on health care expenses, including monthly premiums, deductibles, copays, and coinsurance.
- Compare your options: Review the different types of Medicare coverage options, including Original Medicare (Parts A and B), Medicare Advantage (Part C), Medicare Supplement (Medigap) plans, and prescription drug plans (Part D).
- Consider your preferred providers: Check to see if your preferred hospitals, clinics, and doctors accept the type of Medicare coverage you are considering.
- Get professional assistance: Consider speaking with a Licensed Insurance Representative or visiting a local State Health Insurance Assistance Program (SHIP) for personalized help in choosing the best Medicare coverage for you.
It's important to keep in mind that Medicare coverage options can change from year to year, so it's a good idea to review your coverage each year during the Annual Enrollment Period (AEP) and make any necessary changes to ensure that your coverage continues to meet your needs.
How do I enroll in Medicare?
Enrolling in Medicare is a straightforward process, and there are several ways to do so:
- Online: You can enroll in Medicare online through the Social Security Administration's website (www.ssa.gov). You will need to create an account and provide information about your personal, employment, and health insurance history.
- By Phone: You can call the Social Security Administration at 1-800-772-1213 (TTY users can call 1-800-325-0778) to enroll in Medicare.
- In Person: You can visit a local Social Security office to enroll in Medicare in person. You can find your nearest Social Security office by visiting the Social Security Administration's website.
- By Mail: You can complete a paper application for Medicare and mail it to the Social Security Administration. You can request an application by calling the Social Security Administration at 1-800-772-1213.
When enrolling in Medicare, you will need to provide information such as your Social Security number, birth date, and current mailing address. You may also need to provide information about your current health insurance coverage, if any.
It's important to enroll in Medicare during your Initial Enrollment Period (IEP), which begins three months before the month you turn 65 and ends three months after the month you turn 65. If you miss your IEP, you may face late enrollment penalties and may have to wait until the next General Enrollment Period (GEP) to enroll in Medicare.
What are my options for supplemental coverage once I enroll in Medicare?
Once you enroll in Medicare, you have several options for supplemental coverage to help cover costs not covered by Original Medicare (Parts A and B). These options include:
- Medicare Supplement (Medigap) plans: These plans provide coverage for some of the out-of-pocket expenses not covered by Original Medicare, such as copayments, coinsurance, and deductibles.
- Medicare Advantage (Part C) plans: These plans combine the benefits of Original Medicare and may include additional benefits such as prescription drug coverage.
- Prescription drug plans (Part D): These plans provide coverage for prescription drugs not covered by Original Medicare.
- Employer-sponsored health insurance: If you or your spouse is still working and have access to employer-sponsored health insurance, you may want to consider enrolling in that plan for supplemental coverage.
It's important to compare the different options for supplemental coverage, including their costs, benefits, and restrictions, to determine which option best meets your individual needs and budget. You can compare your options by visiting the Medicare website (www.medicare.gov) or by speaking with a Licensed Insurance Representative
You can enroll in a supplemental coverage plan during the Annual Enrollment Period (AEP) or during a Special Enrollment Period (SEP) if you experience a qualifying life event.