Medicare Blog

medicare what you should know

by Dr. Ibrahim Moen Published 2 years ago Updated 1 year ago
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  1. It doesn't cover everything. Medicare Part A (hospital insurance) covers visits to the hospital, surgeries, lab tests, and other in-patient services.
  2. It'll cost you, but how much depends on your income. Medicare, like traditional health insurance, has monthly premiums, annual deductibles, and co-insurance.
  3. Medicare premiums are tax-deductible. You can deduct some or all of your Medicare premiums when you file your taxes, which reduces your taxable income for the year and saves ...
  4. You'll get some free preventive services. Medicare Part B covers several preventive health services at no cost to you, including a yearly wellness visit, flu shots, cardiovascular disease screenings, ...
  5. Open enrollment is Oct. 15 to Dec. 7. The annual open enrollment period is the time when you can make adjustments to your Medicare coverage and switch between Original ...

Full Answer

How do you know if you qualify for Medicare?

Did you know that you can apply for Medicare online even if you are not ready to retire? And it takes less than 10 minutes! There are no forms to sign and usually no required documentation. We’ll process your application and contact you if we need more ...

How to know if you are eligible for Medicare?

  • You receive Full Medicaid benefits
  • You are a Qualified Medicare Beneficiary (QMB) without other Medicaid (QMB Only)
  • You receive QMB Plus
  • You are a Specified Low-Income Medicare Beneficiary (SLMB) without other Medicaid (SLMB Only)
  • You receive SLMB Plus
  • You are a Qualifying Individual (QI)
  • You are a Qualified Disabled and Working Individual (QDWI)

Does Medicare cover what you need?

The largest and most important item that traditional Medicare doesn't cover is long-term care if the only care you need is custodial. 15 If you are diagnosed with a chronic condition that requires ongoing long-term personal care assistance, the kind that requires an assisted-living facility, Medicare will cover none of the cost.

How well do you know Medicare?

Top 5 things you need to know about Medicare Enrollment

  1. People are eligible for Medicare for different reasons.
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  3. Some are eligible when they turn 65. People under 65 are...
  4. Some people get Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) automatically and some people...
  5. Enrolling in Medicare can only happen at certain times.
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  7. If someone is...

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What they don't tell you about Medicare?

'Medicare Part A covers hospital stays' What they don't tell you: There's either a deductible or daily copay. And if the hospital hoodwinks you into being “under observation,” rather than formally admitting you, your costs are going to be even higher. If you're in Original Medicare, Part A covers hospital stays.

What are 3 benefits of Medicare?

Medicare Advantage plans must offer at least the same level of coverage as Medicare Part A and Part B and many plans offer added benefits. These may include coverage for routine vision care, hearing aids, routine dental care, prescription drug coverage, and fitness center membership.

What are the 3 types of Medicare and what do they provide?

There are four parts of Medicare: Part A, Part B, Part C, and Part D.Part A provides inpatient/hospital coverage.Part B provides outpatient/medical coverage.Part C offers an alternate way to receive your Medicare benefits (see below for more information).Part D provides prescription drug coverage.

What do you know about Medicare?

Medicare Comes With a Cost (People who aren't eligible for free Part A can pay a monthly premium of several hundred dollars.) Part B covers doctor visits and outpatient services, and it comes with a price tag—the standard monthly premium in 2022 will be $170.10, up from $148.50 per month this year.

What part of Medicare is free?

Part APart A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. coverage if you or your spouse paid Medicare taxes for a certain amount of time while working. This is sometimes called "premium-free Part A." Most people get premium-free Part A.

What is the biggest disadvantage of Medicare Advantage?

Medicare Advantage can become expensive if you're sick, due to uncovered copays. Additionally, a plan may offer only a limited network of doctors, which can interfere with a patient's choice. It's not easy to change to another plan. If you decide to switch to a Medigap policy, there often are lifetime penalties.

Whats the difference between Medicare Part A and B?

Part A (Hospital Insurance): Helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care. Part B (Medical Insurance): Helps cover: Services from doctors and other health care providers.

Does Medicare pay for everything?

Original Medicare (Parts A & B) covers many medical and hospital services. But it doesn't cover everything.

Why do I need Medicare Part C?

Medicare Part C provides more coverage for everyday healthcare including prescription drug coverage with some plans when combined with Part D. A Medicare Advantage prescription drug (MAPD) plan is when a Part C and Part D plan are combined. Medicare Part D only covers prescription drugs.

Do I automatically get Medicare when I turn 65?

Yes. If you are receiving benefits, the Social Security Administration will automatically sign you up at age 65 for parts A and B of Medicare. (Medicare is operated by the federal Centers for Medicare & Medicaid Services, but Social Security handles enrollment.)

What insurance do I get when I turn 65?

MedicareMedicare is our country's health insurance program for people age 65 or older.

What do I need to know before turning 65?

Turning 65 Soon? Here's a Quick Retirement ChecklistPrepare for Medicare. ... Consider Additional Health Insurance. ... Review Your Social Security Benefits Plan. ... Plan Ahead for Long-Term Care Costs. ... Review Your Retirement Accounts and Investments. ... Update Your Estate Planning Documents.

How does the new law help doctors?

The law makes it easier for your doctors to work together by offering them support and resources for patient-centered care. If you’re hospitalized, the new law also helps you return home successfully—and avoid going back—by helping to coordinate your care and connecting you to services and support in your community. 4.

Why do you get a 50% discount on Part D?

1. It makes prescription drugs more affordable. If you enter the coverage gap known as the “donut hole,” you will receive a 50% discount when buying Part D-covered brand-name prescription drugs. This discount will be automatically applied at the counter of your pharmacy; you don’t have to do anything to get it.

Does Medicare give you preventive care?

It gives you preventive care services for free. If you have Medicare, you can get free preventive screenings and services like colorectal cancer screening and mammograms. You can also get a free yearly wellness visit to develop and update your personal prevention plan based on current health needs.

How long do you have to enroll in Medicare?

However, the law only allows for enrollment in Medicare Part B (Medical Insurance), and premium-Part A (Hospital Insurance), at limited times: 1 Initial Enrollment Period – a 7-month period when someone is first eligible for Medicare. For those eligible due to age, this period begins 3 months before they turn 65, includes the month they turn 65, and ends 3 months after they turn 65. For those eligible due to disability, this period begins three months before their 25th month of disability payments, includes the 25th month, and ends 3 months after. By law, coverage start dates vary depending on which month the person enrolls and can be delayed up to 3 months. 2 General Enrollment Period – January 1 through March 31 each year with coverage starting July 1 3 Special Enrollment Period (SEP) – an opportunity to enroll in Medicare outside the Initial Enrollment Period or General Enrollment Period for people who didn’t enroll in Medicare when first eligible because they or their spouse are still working and have employer-sponsored Group Health Plan coverage based on that employment. Coverage usually starts the month after the person enrolls, but can be delayed up to 3 months in limited circumstances.#N#People who are eligible for Medicare based on disability may be eligible for a Special Enrollment Period based on their or their spouse’s current employment. They may be eligible based on a spouse or family member’s current employment if the employer has 100 or more employees.

What is a SEP in Medicare?

Special Enrollment Period (SEP) – an opportunity to enroll in Medicare outside the Initial Enrollment Period or General Enrollment Period for people who didn’t enroll in Medicare when first eligible because they or their spouse are still working and have employer-sponsored Group Health Plan coverage based on that employment.

How long do you have to wait to get Medicare if you have ALS?

People under 65 are eligible if they have received Social Security Disability Insurance (SSDI) or certain Railroad Retirement Board (RRB) disability benefits for at least 24 months. If they have amyotrophic lateral sclerosis (ALS), there’s no waiting period for Medicare.

How long is the initial enrollment period for Medicare?

Initial Enrollment Period – a 7-month period when someone is first eligible for Medicare. For those eligible due to age, this period begins 3 months before they turn 65, includes the month they turn 65, and ends 3 months after they turn 65. For those eligible due to disability, this period begins three months before their 25th month ...

Does COBRA count as current employment?

But, there are special rules that they need to know. For example, employer coverage for retirees or through COBRA doesn’t count as current employment , so these individuals don’t qualify for a SEP to enroll in Medicare later. A different set of rules apply if the person has Medicare based on disability or ESRD. 5.

What is Medicare Advantage?

Or, you can go an alternative route by signing up for Medicare Advantage, which provides medical and prescription drug coverage through private insurance companies. Also called Part C, Medicare Advantage has a monthly cost, in addition to the Part B premium, that varies depending on which plan you choose.

How long does it take for a Medicare plan to make a decision?

If you think your health would be seriously harmed by waiting for a decision, you can ask for a fast decision to be made and if your doctor or Medicare plan agrees, the plan must make a decision within 72 hours.

How much does Medicare pay in 2021?

Surcharges are based on adjusted gross income from two years earlier. In 2021, high earners pay $207.90 to $504.90 per month for Part B, depending on their income level in 2019, and they also pay extra for Part D coverage, from $12.30 to $77.10, on top of their regular premiums.

When does Medicare open enrollment start?

Open enrollment runs from Oct. 15 to Dec. 7 every year during which you can change Part D plans or Medicare Advantage plans for the following year, or switch between Medicare Advantage and original Medicare. Advantage enrollees also can switch to a new Advantage plan or original Medicare between Jan. 1 and March 31.

How much will the 2021 Medicare premiums be?

Surcharges are based on adjusted gross income from two years earlier. In 2021, high earners pay $207.90 to $504.90 per month for Part B, depending on their income level in 2019, and they also pay extra for Part D coverage, from $12.30 to $77.10, on top of their regular premiums.

What is the most popular insurance plan?

Plan F is the most popular policy because of its comprehensive coverage, but as of 2020, Plan F (along with Plan C) is unavailable for new enrollees. The closest substitute for Plan F is Plan G, which pays for everything that Plan F did except the Medicare Part B deductible.

Does Medicare cover telehealth?

Medicare Expands Telehealth Offerings. Although most Medicare Advantage plans have been covering telehealth for years, traditional Medicare used to restrict the service only to certain devices and practitioners, and patients had to be at a Medicare facility.

What is Medicare Part A?

Part A is the hospital insurance component of Original Medicare. In addition to inpatient care in a hospital, skilled nursing facility and religious nonmedical health care setting, Part A also covers hospice and home health care.

Why are MA plans so popular?

MA plans are popular because they often include prescription drug coverage, and some are premium-free. Additionally, in 2020, there is more emphasis on additional benefits, such as transportation to the doctor’s office, over-the-counter drugs, adult day care and wellness programs.

Does Medicare Supplement cover foreign travel?

Medicare enrollment in Medicare Supplement plans, otherwise known as Medigap, is attractive to beneficiaries who are interested in Original Medicare but want to add insurance to fill coverage gaps. Some Medigap plans offer out-of-pocket limits and cover foreign travel emergency care. The two Medigap plans that cover the Part B deductible for current plan participants are Plans C and F, but they will no longer be offered for those coming into Medicare enrollment for the first time in 2020.

Is prescription drug coverage part of Medicare?

Prescription drug coverage is not part of Original Medicare (Parts A and B), but coverage can be purchased through a private Medicare-approved insurance company. Another option is to enroll in Medicare Advantage, known as Part C, which encompasses parts A and B, and often Part D. When shopping for drug plans, check to ensure that your current medications are covered. Often the drugs will be listed in tiers that signify the level of coverage.

Is Medicare good for older people?

The Medicare program continues to be vital to retirees age 65 and older, younger people with certain disabilities, and people suffering from amyotrophic lateral sclerosis, commonly known as ALS or Lou Gehrig’s disease.

How many classes of drugs does Medicare cover?

There are many drugs covered under Medicare. Plus, every plan must cover the six protected classes. If you have medications that need coverage, use the Medicare plan finder tool to identify the policy that will cover your medications.

What is Medicare Part C?

Medicare Part C is a Medicare Advantage plan. These plans sometimes have a $0 per month premiums, and many of them include Part D drug coverage. However, there are some pitfalls to Medicare Advantage plans that you need to know before signing up.

What happens if you don't pay Medicare?

But, if you don’t pay the premium on a Medicare Advantage or Medigap plan, they can drop you. Also, if you don’t pay your Part D premium, the drug plan can drop you. Usually, they give multiple notices before the plan terminates your policy.

What is a medicaid supplement?

A Medigap plan is a supplemental option for Medicare. Medigap plans are also Medicare Supplement plans; these policies fill the gaps in Medicare. So, when Medicare would otherwise charge you 20% or a deductible, the Medicare Supplement could instead pick up the bill.

Does Medicare pay less if you have a low income?

The cost of Medicare depends on many things. Those with a low income will likely pay less than the standard amount and may qualify for Medicare and Medicaid. Those with a higher income will likely pay more for Part B; this is called the Part B Income Related Monthly Adjustment Amount.

Is Medicare mandatory?

Of course, Medicare isn’t mandatory, so you can choose whichever option makes the most sense for your situation. You can also always consult your benefits administrator at the office where you work to identify your options.

What is Medicare Part D?

Medicare Part D is optional prescription drug coverage that is also provided by private insurance companies. Both Part C and Part D are regulated by the federal government. You can compare Part D plans available where you live and enroll in a Medicare prescription drug plan online when you visit MyRxPlans.com.

What is Medicare and Medicaid?

Medicare is administered by the Centers for Medicare & Medicaid Services and is an entitlement program similar to Social Security. This means that most U.S. citizens earn Medicare health insurance eligibility by paying taxes for a set period of time.

How many people are covered by Medicare?

Fact 2: Medicare covers more than 61 million people. Medicare had over 61 million enrollees in the United States in November 2019, according to statistics from the Centers for Medicare & Medicaid Services (CMS). 1.

When is Medicare open enrollment?

The Medicare Open Enrollment Period for Medicare Advantage plans and Medicare Part D prescription drug plans runs from October 15 to December 7. During this time, you can make several changes such as joining a Medicare Advantage plan or a Medicare prescription drug plan.

When will seniors be automatically enrolled in Medicare?

Fact 4: Some seniors are enrolled in Part A automatically. Some seniors will be enrolled in Medicare Part A automatically around their 65th birthday. If you are not automatically enrolled, you can enroll in Medicare Parts A and B during certain enrollment periods.

Can you get Medicare Advantage?

Fact 6: You can get Original Medicare benefits through a Medicare Advantage plan. Medicare Advantage plans (also known as Medicare Part C) cover the same benefits as Original Medicare but are provided by private insurance companies. Medicare Advantage plans must provide the same benefits as Medicare Part A and Part B.

Is Medicare for seniors?

Fact 1: Medicare is for seniors and the disabled. Medicare is a federally-funded health insurance program for people age 65 or older and some younger people who have qualifying disabilities or who have end-stage renal disease (ESRD).

How often do Medicare benefits change?

If you are enrolled in either a Medicare Advantage plan or a Part D drug plan, your benefits can and likely will change each year. Your insurance company can make changes to the plan’s premium, coverage, copays and networks every year.

What is an AEP in Medicare?

One of the biggest misconceptions of Medicare is that the Annual Election Period (AEP) is used for enrolling in Medigap plans without going through underwriting. This is incorrect. The AEP is only for Medicare Advantage plans and Part D drug plans.

Do doctors know about Medicare?

Many doctor office employees don’t know everything about Medicare. That’s not their job. So, it’s normal for them to get confused about how Medicare works and they could misinform you about which plans your doctor accepts.

Do you pay Medicare Part A during your working years?

Many Medicare beneficiaries are both surprised and upset about this. You might be thinking, “I have been paying into it for forever, it should be free!” The truth is, you only pay into Medicare Part A during your working years. That’s why for most people, Part A hospital coverage costs nothing at the time of enrollment.

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