How does Medicare work? Do I need it? What does it cover?
These are the main questions we hear from folks approaching Medicare. While finding the answers can be difficult on your own, you don’t have to figure it out yourself if you don’t want to. We’re happy to coach you through the process, and help as much (or little) as you like.
Medicare is the federal health insurance program, and it was created in 1965. This program was created to cover older Americans (those 65 years or older.) In addition, some folks with medical conditions or disabilities can get coverage from Medicare.
Most people will join Medicare when they turn 65 years old. In order to be eligible, most Americans will have to have worked for a minimum of 10 years. If you still have employer coverage when you turn 65, you will likely enroll in Medicare when you retire.
What Parts of Medicare do you need? And which are mandatory?
Usually, most people will need to enroll in Part A and Part B during their initial enrollment period to avoid penalties.
And for those folks already receiving Social Security benefits, they will automatically be enrolled in Part A.
Read below for an overview of the 4 Parts of Medicare (A,B,C,D)
Part A covers mostly any time you would spend at the hospital. This includes inpatient care, skilled nursing, as well as needs required in a nursing home or for home health care needs.
Part A does not cover long term care, like longer periods of time in a nursing home. A good option is to purchase long-term care insurance in case you think you will use a nursing home down the road.
For most people, you will not have to pay a premium for Part A (you already paid into it during your time in the workforce.)
It is important to know that Part A is not totally free however. Medicare will charge a deductible any time you need to be admitted into a hospital. Supplemental insurance can help cover this.
If you have any questions regarding how to enroll in Part A, or what is covered, we are happy to help you!
Part B of Medicare will cover your doctor visits, tests and screenings, any medicare equipment you need, ambulances, and other services.
This can include cancer treatments (radiation/chemo), imaging, and dialysis.
Included also in Part B are things like flu shots, mammograms, colonoscopies, and more.
You should know, Part B will generally cost more than Part A. For some, it may be an idea to delay signing up for Part B. We can help you do this, and avoid any penalties.
If you already are taking Social Security benefits at age 65, you will be automatically enrolled. Otherwise, you will need to enroll at age 65. It is important to apply for coverage before you will need it to ensure you don't have a gap in your insurance.
Medicare Part C is an alternative to traditional Medicare, and you should know they are optional. A Part C Medicare plan is a private Medicare plan - one that pays instead of normal Medicare.
What you get with a Part C (Medicare Advantage, or MA) plan, is coverage that includes Parts A, B, and likely D into one plan.
You will still enroll in Part A and Part B, as well as Part C. MA Plans sometimes pay for things not included in original Medicare, like dental and vision.
For these plans, you will likely choose and HMO or PPO. With an HMO, you will choose a primary care provider. With a PPO, you will have a network of doctors and facilities to choose from.
Part D of Medicare will pay some of your retail Rx drug costs. These plans have premiums, out-of-pocket costs, and copays. Some plans also have an annual deductible.
It is important to choose the right plan depending on what prescription drugs you are taking regularly.
Part D differs to Part A and B in that you will not enroll through Social Security. To enroll in Part D, you will choose from private insurance plans offered in your county.
Please note, these plans are optional, and there are rules for when you can enroll (and dis-enroll) from Part D.
How much will my Medicare cost? Medicare isn’t free? Is Part A free? What are the premiums I will have to pay?
Most people, in fact, will have to pay some premiums for their Medicare coverage. The premiums (or lack of) is different between Part A, B, C, and D. It really comes down to your individual situation.
You probably want to plan ahead – that means you are ahead of the game!
If really want to drill down and figure out your Medicare, we are happy to help you. In fact, in one 30-min Medicare Consultation phone call (free), you can be on your way to enrolling yourself in Medicare and knowing exactly how much it will cost you.
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