Medicare FAQs

What is Medicare?

Medicare is a federal health insurance program for people who are 65 or older, people with certain disabilities, and people with end-stage renal disease. Medicare 4 parts: Part A covers hospital stays, hospice care, and some home health care services. Part B covers doctor visits, preventive care, some medical equipment, and a very limited amount of outpatient drugs. Part C is known as Medicare Advantage and is offered by private insurance companies that offer additional benefits. Part D is prescription drug coverage.

What Medicare Part B Covers

Many people are confused about what Medicare Part B covers and how much it costs. Original Medicare Part B covers doctor visits, preventive care and services, and medically-necessary “services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.” Medicare.gov. This includes durable medical equipment (DME), mental health services, and some outpatient drugs. The current cost of Medicare Part B monthly premium for 2023 is $164.90 (or more, based on your income), which you have to pay through your checking or savings account. It is not deducted from your Social Security check.

Are Medicare and Medicaid the Same?

No. The Medicare versus Medicaid question also comes up a lot. Medicare is a health insurance program for people over 65, with specific disabilities, and people with end-stage renal disease. Medicaid is also a Federal health insurance program, but it helps low-income people of all ages and abilities stay healthy and get the medical care they need. A person can receive both Medicare and Medicaid benefits if they are eligible. Medicare or Medicaid? One or both can be right for you. If you have more questions about your Medicare coverage, call the Medicare 800 number at 1-800-633-4227 or 1-800-MEDICARE.

What is the difference between original Medicare and Medicare Advantage?

Original Medicare is the traditional fee-for-service program that is run by the federal government. It includes Part A (hospital insurance) and Part B (medical insurance). Medicare Advantage plans, also known as Part C, are offered by private insurance companies and provide the same benefits as original Medicare but may also include additional benefits such as vision, hearing or dental coverage.

When can I enroll in Medicare?

The Initial Enrollment Period (IEP) is the seven-month period that begins three months before the month you turn 65 and ends three months after the month you turn 65. During this period, you can sign up for Medicare Part A (hospital insurance) and Part B (medical insurance). If you don’t sign up for Part A or B during this period, you may have to pay a late enrollment penalty if you decide to sign up later.

What other enrollment periods are there?

You can join, switch, or drop a Medicare Health Plan or a Medicare Advantage Plan (Part C) with or without drug coverage during these times:

Initial Enrollment Period. When you first become eligible for Medicare, you can join a plan.

Open Enrollment Period. From October 15 – December 7 each year, you can join, switch, or drop a plan. Your coverage will begin on January 1 (as long as the plan gets your request by December 7).

Medicare Advantage Open Enrollment Period. From January 1 – March 31 each year, if you’re enrolled in a Medicare Advantage Plan, you can switch to a different Medicare Advantage Plan or switch to Original Medicare (and join a separate Medicare drug plan) once during this time. Note: You can only switch plans once during this period.

What drugs are covered by Medicare Part D?

Each plan has its own list of covered drugs, known as a formulary. The formulary typically includes a wide range of drugs, including those used to treat common conditions such as high blood pressure, diabetes, and high cholesterol. However, not all drugs are covered by every plan, and some plans may place certain drugs on a higher cost-sharing tier, requiring you to pay more out of pocket for those drugs.

How do I choose the right Medicare plan for me?

When choosing a Medicare plan, it’s important to consider your healthcare needs, budget, and preferred providers. You can also get help choosing a plan from a licensed insurance agent or a counselor at your local State Health Insurance Assistance Program (SHIP).

How much does Medicare cost?

The cost of Medicare varies depending on the coverage you choose and your income level. Part A is usually free, while Part B typically requires a monthly premium. The cost of Medicare Advantage plans and Part D plans can vary depending on the plan you choose and your location. Some people may also pay higher premiums based on their income.

What is not covered by Medicare?

Medicare does not cover certain services, such as long-term care, dental care, or eye exams. Medicare Parts A and B do not cover the cost of hearing aids, but some Medicare Advantage (Part C) plans may offer some coverage, depending on your plan. Some prescription drugs may also not be covered. Additionally, Medicare does not cover most of the cost for custodial care or long-term care, such as assistance with activities of daily living, like bathing, dressing, or eating.

How can I save money on my Medicare plan?

To save money on your Medicare plan, it’s important to compare the plans carefully and choose the one that best meets your needs. You can also look for extra help programs that can help you pay for your Medicare costs, such as the Medicare Savings Programs (MSPs) or the Extra Help program.

What are the advantages and disadvantages of Medicare Advantage plans?

Some of the advantages of Medicare Advantage plans include lower out-of-pocket costs, additional benefits such as dental or vision coverage, and the convenience of receiving all your health coverage from one provider. However, some of the disadvantages include a smaller network of providers, less flexibility, and the potential for increased out-of-pocket costs, depending on the plan you choose.

Who can help me choose a Medicare plan?

You can get help choosing a plan from a licensed insurance agent, a counselor at your local State Health Insurance Assistance Program (SHIP), or a trusted advisor.

Can I change my Medicare plan?

Yes, you can change your Medicare plan during certain times of the year, such as during the Annual Enrollment Period (AEP) or when you experience certain life events, like moving to a new area. It’s important to review your coverage regularly to ensure that it continues to meet your needs and budget.

How does a Medicare Supplement (Medigap) plan work?

Medicare Supplement plans (Medigap) are insurance plans that can help pay for some of the out-of-pocket costs that original Medicare doesn’t cover, like copayments, coinsurance, and deductibles. These plans are sold by private insurance companies and can be used in conjunction with original Medicare. Keep in mind that not all Medigap plans are available in all states and the cost can vary depending on the insurance company you choose. Medicare Supplement plans are a good option for snowbirds and people who travel frequently because you don’t have to be in-network as you do with Medicare Advantage plans.

How is my income used to determine my Medicare premium?

The income used to determine your Medicare premium is based on your most recent tax return, specifically your Modified Adjusted Gross Income (MAGI). If your income is above a certain threshold, you’ll pay a higher premium for Part B and Part D coverage. The income thresholds change each year, but you can check with Social Security or the Internal Revenue Service (IRS) for current information.

Can I opt-out of Medicare if I have other insurance options?

It’s possible to opt-out of Medicare if you have other insurance options, but it’s important to understand the potential consequences of doing so. If you opt-out of Medicare and later decide to enroll, you may have to pay a late enrollment penalty, and you may not be able to enroll in certain plans or during certain times of the year.

Can I have both Medicare and Medicaid?

Yes, you can have both Medicare and Medicaid. Medicaid is a government-funded health insurance program for people with low income, whereas Medicare is a federal health insurance program for people who are 65 or older, people with certain disabilities, and people with end-stage renal disease. Medicaid services can help with the cost of Medicare, but you have to qualify for Medicaid based on your income and asset level. Check with your state to see if you are eligible for Medicaid.

Is there a difference between Medicare and Medigap plans?

Medicare is a federal health insurance program that provides coverage for people who are 65 or older, people with certain disabilities, and people with end-stage renal disease. Medigap plans, also known as Medicare Supplement plans, are private insurance plans that help pay for some of the out-of-pocket costs that original Medicare doesn’t cover. They can be used in conjunction with original Medicare to provide additional coverage.

Does Medicare cover pre-existing conditions?

Yes, Medicare covers pre-existing conditions. Medicare guarantees that everyone is eligible for coverage regardless of their health status or medical history.

Will Medicare cover me if I travel outside of the United States?

Original Medicare does not cover medical care that you receive while traveling outside of the United States. However, some Medicare Advantage plans may offer coverage for emergency care outside of the United States. It’s important to check with your plan for specific coverage details and to make sure you have additional travel health insurance before leaving the country.