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Are You a Medicare First Timer?
Here's What You Need To Know
The Medicare national health insurance program helps US seniors 65 and older pay for their medical expenses. Nearly every American senior of qualifying age enrolls in Medicare because it has high satisfaction ratings and dramatically alleviates healthcare costs for retirees.
What's up With the Medicare Alphabet?
The four different Medicare parts are divided by letter: Medicare part A, Part B, Part C, and Part D. There are also Medicare supplement insurance plans (which are optional and potentially cost-effective). The most important thing that first-timers need to know are the ins and outs of Original Medicare, AKA Medicare Parts A and B.
Medicare Parts A and B (Original Medicare): Medicare Parts A and B are the base package which most people simply referred to as "Medicare". They may also refer to it as Original Medicare. Medicare Advantage health insurance policies start by offering the exact same types of coverage as Original Medicare and give customers the option of adding things like dental and/or vision insurance. Medicare supplement insurance policies are private health insurance policies which fill the "gaps" inherent in Original Medicare coverage.
Medicare Part A: People in the industry sometimes referred to Medicare part A as "hospital insurance". If you are over the age of 65 and currently receiving Social Security, you absolutely have to enroll in Medicare part A.
Once you enroll in Part A you'll have access to:
- Hospice care
- Inpatient hospital care
- Health visits another hospital care
- Limited stays in hospitals and or skilled nursing facilities
Supplemental Coverage: Original Medicare covers a lot, but it doesn't cover everything. You're going to need some form of supplemental coverage if you want to be truly secure. A majority of these plans are run by privately-held health insurance companies.
Certain common medical expenses - such as the first 3 pints of medically necessary blood transfusions, emergency care while traveling abroad, or prescription drugs - will not be paid for by Medicare alone. Similarly, co-payments and deductibles for Medicare Part B can be as high as 20% of the cost of care. But you can avoid paying for these expensive out-of-pocket with some kind of Medicare Supplement plan.
Medicare Advantage (Medicare Part C):
- Replaces your Original Medicare with an identical health insurance plan from a private company
- These plans are legally required to offer at least the same coverage as Original Medicare; many
offer that and more, such as a $0 monthly premium and prescription drug coverage
- Medicare Advantage plans come with a $6,700 out-of-pocket maximum
- Some Medicare Part C plans include additional coverage like hearing aids or dental care
- Unlike Original Medicare, Medicare Advantage plans have smaller medical networks of doctors
and hospitals to choose from
Medicare Part D: (Prescription Drug Coverage):
- In almost all cases, Original Medicare willl not cover your prescription drugs
- You can get prescription drug coverage through Medicare Part D if you add it to Original Medicare
or bundle it with a medicare Part C plan
Medicare Supplement Insurance (Medigap):
- Whatever Original Medicare does not cover, there's a Medigap insurance policy that will
- The smallest and most affordable plans start by covering gaps in hospital costs and extending
hospital stays when necessary
- The next tier of plans will cover Medicare Part B coinsurance in full
- The most comprehensive plans can help reduce Original Medicare deductible costs, as well as excess charges
Basic Medicare Facts
During the year in which you turn 65 years of age, you will have a seven month window in which to apply for Original Medicare. That enrollment period starts on the first of the month which is 3 months before your birthday month. The enrollment period ends on the last day of the month three months after your birthday month. The infographic below demonstrates this more clearly:
Medicare is not free, but it is much more affordable than most private health insurance plans for people 65 and older.
If you have worked long enough in your life to qualify for Social Security benefits, you will not have to pay a monthly premium for Medicare part A. With Original Medicare, you will have to pay a deductible for each hospital stay; only after that deductible is paid will Medicare Part A start sorting out the rest of your costs. It should be noted that most Medicare Supplement and Medicare Advantage plans will help you cover this deductible.
Most seniors are paying around $134 a month for their Medicare Part B premium. Your payment may be higher or lower depending on your tax returns over the last two years. Also, with Medicare Part B, you will be required to pay 20% of your total medical costs - unless you have Medicare Advantage or a Medicare Supplement plan which agrees to help you pay for these expenses.
Seniors who are automatically enrolled in Medicare will receive their official Medicare card through the mail about two to three months before they become eligible. For seniors who do not automatically enroll, their official Medicare card will arrive in the mail three weeks after they apply for Medicare coverage. You can expedite the arrival of your card by applying for Medicare as soon as possible. Once your coverage begins, you can immediately access your Medicare benefits and health care options.
Seniors will become eligible for Medicare in one of two ways:
- You will automatically qualify during the year of your 65th birthday
- By qualifying for Social Security disability insurance benefits or being diagnosed with end-stage renal disease (ESRD)
These requirements are uniform for all American citizens across all 50 states.
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