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CURIOUS ABOUT MEDICARE? NEED MEDICARE INFORMATION?

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If you’re looking for the best information on Medicare and what it means for your health future, this is the perfect place to start. Since not everyone is familiar with the Medicare plans and systems, let’s start at the very beginning.

WHAT EXACTLY IS MEDICARE?

Medicare is a federal health program that is intended for people who are aged 65 and older. However certain younger individuals can also qualify for this insurance if they have specific diseases or end of life issues. But we’ll come back to that at a later time.

Remember, Medicare is basically government health insurance and you need to pay your fair share of costs.

Medicare was signed into law in 1965 under President Johnson. Since that time, the programs have been modified and expanded to include additional treatments, therapies and expanded coverage.

As of the most recent data, fewer than 50 million Americans are on Medicare provided health insurance.

I KEEP HEARING ABOUT MEDICARE PART A AND PART B, WHAT’S THE DIFFERENCE?

Like any health plan Medicare has different parts. Federal Medicare consists of four different parts. There’s the hospital insurance, Medicare Part A. The medical insurance, Medicare Part B. The Medicare Advantage, Medicare Part C. Lastly there’s Prescription Drug Coverage, Medicare Part D.

Now I can tell you have questions… like what’s the difference between the parts?

Well, Medicare Part A or the hospital insurance part helps cover the cost of inpatient care in a hospital or nursing home. It also covers part of the cost of some home health care and hospice care. Now Medicare Part A is premium free (for those who qualify), meaning you don’t have to pay a monthly insurance premium, but you are expected to cover part of the cost of treatment through deductibles or co-insurance.

Medicare Part B or the Medical Insurance Program is very different. This part of the Medicare insurance covers stuff like outpatient medical services, doctors’ visits and sometimes even supplies. Now, you don’t need to get Medicare Part B if you don’t want… but if you do want coverage there’s a monthly premium, an annual deductible and Co-pay for service.

So, it’s good coverage for normal Doctor visits… but it will cost you money in the form of premiums.

Medicare Part C is also called Medicare Advantage. Now here’s the twist. Instead of getting your Medicare benefits from the government, Medicare Part C gives you the option to have your insurance provided by a private insurance company. These are called Medicare Advantage Plans. These plans can cover all the hospital coverage (part A) and doctor visits (part B) and even prescription Drugs (part D)… don’t worry we’ll get to part D coverage in a moment.

The advantage of the Medicare Advantage program is the ability to work with a traditional insurance company. When you join an advantage plan the insurance will set up a network of doctors for you to see, and often times the plan covers your prescription drug cost or Medicare Part D as well. Of course it costs money for this coverage so you’ll have a monthly premium, a deductible, and sometimes a small co-pay as well.

There’s another type of coverage called a Medicare Supplement plan… it’s like buying regular insurance, and it typically allows you to visit any doctor. As far as cost, supplemental Medicare insurance often eliminates the co-pays, but you’ll still have a monthly premium. Keep in mind that these plans often exclude Medicare part D prescription coverage.

And that brings us to Medicare Part D, the Prescription Drug coverage. Sometimes this is included in a Medicare Advantage plan, or it can be bought separately. This covers the high cost of prescription drugs while you simply pay the monthly premiums and a small co-pay. It makes the most sense if you have a lot of prescriptions, or are on expensive drug treatments. Keep in mind some veterans can get part D coverage from the Department of Veterans Affairs.

Now you know all about the four parts to Medicare… so that brings us to the next question…

HOW DO I SIGN UP FOR MEDICARE?

Signing up is easy. All you need to do is make sure you are eligible. So, who is eligible?

To be eligible, you need to be over the age of 65 (except in certain circumstances). You must be a U.S. Citizen or Permanent Legal resident for the last 5 years… and you or a spouse must have paid Medicare taxes for at least 10 years.

Once you turn 65 most Americans are eligible for Medicare. Frequently when you start receiving social security benefits, they will also send you the application information for Medicare 3 months BEFORE your 65th birthday. Medicare signup is straight forward… and you can even sign up online at socialsecurity.gov.

Don’t delay. You can sign up for Medicare benefits up to three months BEFORE your 65th birthday.

However keep in mind, while you can sign up three months early, once you turn 65 there is a signup deadline… you only have 4 months to get it done. Officially it’s a 7 month window… the three months before your birthday month, your birthday month, and three months after your birthday month.

Now here’s the stick… if you don’t sign up for Medicare in your 7 month window, you could “Face lifetime penalties” for not enrolling on time.

Look, keep life simple… just sign up early. Don’t wait.

WHAT IF I’M STILL WORKING?

This portion can get a bit complicated. Be sure to talk to your benefits administrator with any questions that arise. If you are covered by a corporate insurance plan, you can still sign up for Medicare Part A because there are no monthly premiums. Once you have done this you can delay taking Medicare Part B and Medicare Part D.

However, once you sign up for any part of Medicare you can’t contribute to an HSA. If you have an HSA it’s important to know… If you have no idea what an HSA program is… then it probably won’t impact you!

If you decided to delay signup, just keep in mind this comes with paperwork too… I won’t bore you with the details here, but you’ll need to document everything… you don’t want to get fined by the government later on!

Now let’s dive into the dirt on Medicare coverage.

WHAT DOES MEDICARE EXCLUDE FROM COVERAGE?

You know that sinking feeling you get when you realize you’re going to get hit with a big bill… well, avoid that when you visit the Doctor. Medicare covers a ton of stuff, but there is stuff not covered by Medicare Parts A and B… things like:

  • Long term custodial care
  • Routine dental care including Dentures
  • Cosmetic surgery
  • Acupuncture
  • Naturopathy
  • Hearing aids or related exams
  • Routine eye exams
  • Eyeglasses
  • Care OUTSIDE of the U.S.

This is why some people get Medicare Part C, the Medicare Advantage plan, or Medicare Supplemental coverage. Sometimes these insurance plans cover some of the items listed above, but you need to make sure and check the policy!

Keep in mind, Medicare Parts A and B don’t cover prescription drugs either… so make sure you either understand the costs or get Medicare Part D coverage!

WHAT IF I MAKE THE WRONG CHOICE?

There is no need to stress out about all these choices… if you pick one and discover it’s not what you need, you can change your Medicare selections.

If you want to change Medicare plans, you need to do it between October 15 and December 7th… and the change will become effective on January 1 the next year.

If you’re on a Medicare Advantage Plan (Part C) and want to drop that… the dates are January 1 to February 14th.

Of course like any government plan it’s not all black and white… there are exceptions, exclusions and other change dates, so do your research first before doing anything!

SO WHAT’S THE TOTAL COST OF MEDICARE?

We have seen many different quotes and prices, and it depends on if you are doing Part C and part D Medicare coverage… but Medicare part A is Free (remember you have to pay for a portion of the coverage) Medicare Part B which covers doctor visits runs just over $100 a month. Medicare Part C and the supplemental coverage costs vary across the board. For Prescription coverage, Medicare part D, the costs vary as well.

Sorry but it’s like anything in the insurance world… it depends on who you are, where you live, and what kinds of coverage you want.

HOW DO I PAY FOR MEDICARE?

This is the easy part… if you just have Medicare Part A there is no payment unless you go to the hospital.

For Medicare Part B, the cost is deducted from your Social Security payments… and if you’re not getting Social Security yet, they will bill you every three months. You can send in a check or even sign up for auto payments with your bank.

WHAT IF I CAN’T AFFORD THE MEDICARE COSTS?

Well, if you can’t afford the Medicare costs, there are some programs to help people with limited incomes. Check with your state Medicaid program. Medicaid is a state run assistance program that helps low income individuals. They can often help with Medicare Part B and Medicare Part D premiums.

STILL HAVE MORE QUESTIONS?

Here’s what you can do…

First, Sign-up for our FYIMedicare.com newsletter. Every week we’ll send you important information on Medicare, Medicaid, Social Security, Healthy living programs and specific ways to improve your happiness and well being.

Signup right now, you don’t want to miss out on any important news and information.

Second, for questions on Medicare Part A or Medicare Part B you can contact the Social Security Administration.

For questions on Medicare Part C, the Medicare Advantage Plans, or Medicare Part D, the Prescription Drug plan, you can contact Medicare directly.

If you’re working with an independent insurance company their health plan administrators can help you directly.

Finally, any other questions can be directed to the State Medicaid offices and most state departments of health and human services (or similar state departments).

We hope this information is useful… and don’t forget to sign up for our free newsletter FYIMedicare.com!