Medicare Answers to Common Medicare Questions

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Many individuals have questions about Medicare. Luckily, numerous unbiased resources can provide answers. Best way to find the medicare consulting.

Your state insurance department or corporation commission should have information about Medicare options in your state. Some also offer SHIPs (State Health Insurance Assistance Programs), which offer confidential and objective insurance advice for free.

What is Medicare?

Medicare, offered through the federal government, provides health coverage for those aged 65 or over or those younger who have disabilities such as Lou Gehrig’s disease (ALS) or end-stage renal disease (ESRD). Medicare Part A covers hospital stays and some home healthcare, Part B provides physician visits and other medical care, and Part D offers prescription drug coverage; additionally, some people may purchase additional Medigap policies from private providers for added coverage.

All Medicare plans adhere to Medicare rules, providing the same basic benefits. Premiums, out-of-pocket costs, and coverage differ between plans. Each must also maintain a list of drugs covered (known as its formulary), which may change throughout the year, and provide notice 60 days in advance when this will happen.

Some individuals may qualify for both Medicare and Medicaid, a joint federal-state program for low-income individuals. Such individuals are known as dual eligibles and could use Medicaid funds to cover Medicare-covered services like copayments and deductibles.

Medicare’s finances are managed through two trust accounts that hold all receipts and expenses, particularly Treasury securities; their proceeds are used to cover beneficiaries’ healthcare costs.

What are the parts of Medicare?

Medicare covers four parts: A, B, C, and D. Part A is hospital insurance, which pays for inpatient hospital stays, care at skilled nursing facilities or hospice facilities, and some home health services. Part B covers doctor visits and outpatient procedures, as well as equipment, supplies, and diagnostic screenings, and typically has a monthly premium associated with it.

Part C, Medicare Advantage plans offered through private health insurers approved by Medicare, typically combine Parts A and B into one plan and may offer additional coverage, such as vision, hearing, or dental coverage. Part D can be added to Original Medicare as well as Medicare Advantage plans.

The amount you owe for each component depends on your income and how long you and/or your spouse have contributed to Medicare; if neither has contributed sufficiently, higher premiums for Parts A and B could apply. Please visit our Medicare premiums page to find out more.

Individuals who were unable to enroll during their initial enrollment period due to circumstances beyond their control, such as illness or injury, can apply for a Special Enrollment Period (SEP). Please visit our Medicare SEPs page for more details.

Do I need to sign up for Medicare?

Some people receive Medicare Part A (hospital insurance) and/or Part B (medical insurance) coverage automatically; others must actively sign up. This can usually be done online, on the phone, in person, or at a Social Security office. Most Americans enroll when they turn 65; however, if you are still working and covered under your current employer/spouse’s employment coverage, you could sign up earlier if eligible.

The Initial Enrollment Period is generally the ideal time to enroll in Parts A and B of Medicare. This three-month window, beginning the month before your birthday, allows you to choose enrollment; failure to do so could incur late enrollment penalties.

If you are covered under an employer group health plan, delaying Part B might make sense. You can do this by reaching out to their benefits administrator. However, be mindful that once Medicare takes over coverage from them, they typically stop making payments, which could create coverage gaps of considerable duration.

Most people choose to combine Original Medicare (Parts A and B) with a Medicare Advantage Plan (Part C) to obtain prescription drug coverage as well as vision, dental, hearing, and fitness coverage in one plan. Our experts can help you explain all your available options to ensure you sign up for coverage at the right time without incurring penalties.

How do I get help paying for Medicare?

Medicare may not be free, but you may still find assistance with its costs. Various programs—some federal, some state-run —may assist based on your income and assets; additionally, some pharmaceutical companies provide programs designed to lower prescription drug costs for Medicare beneficiaries.

At any time before or after enrolling in Medicare Part D prescription drug coverage (deductibles and copayments), you can apply for Extra Help paying these costs at any time – either before or after enrollment. When making this application, you will need to provide information about your income and resources as well as apply for Medicare Savings Programs, which provide state-run assistance in paying Medicare Part A premiums, deductibles, and coinsurance costs.

Each year, Social Security sends out a letter detailing your level of Extra Help eligibility, Medicare drug plan options (if not declined by you), automatic enrollment status (and premium information if any is applicable), and potential payments due in future years.

Extra Help doesn’t usually require applying, but if your income or assets change, you may need to reapply. Reapplying can be done online, by phone, or by mailing in a form; help may also be available from the program administrator. Ask your doctor or pharmacy if there are generics or cheaper brand-name drugs that might work equally well but cost less; additionally, check whether mail-order options or discounts exist in their drug supply network.

How do I choose a Medicare plan?

Medicare Advantage plans (Part C), which combine Part A and B coverage, or stand-in Medicare Advantage prescription drug plans (Part D), offer extra benefits such as vision, dental, and hearing coverage. These plans are provided by private insurers, who must comply with Medicare coverage standards to be approved as Medicare Advantage plans.

Before selecting a plan, take some time to assess your healthcare needs and preferences. Do you prefer the flexibility of seeing any doctor or hospital or prefer certain specialists and hospitals within a network? For Medicare Advantage plans, check what doctors, specialists, and hospitals are part of the network. Also, be sure to keep a list of your medications handy while reviewing each plan’s formulary regularly to stay ahead of any changes that might arise from year to year.

Consider whether or not you have other forms of coverage, like employer or union benefits or military or veterans’ benefits. If that’s the case for you, contact a State Health Insurance Assistance Program (SHIP) for free personalized health insurance counseling – you can find one by searching Medicare.gov/findashp/

When you’re ready, enrolling in Medicare Advantage or Part D plans during the Annual Election Period from Oct. 15 to Dec. 7 can be done quickly and seamlessly. Reevaluating your choices each fall allows for plan adjustments or switching if they are no longer fit; should your mind change after making this choice, you have up to seven months to reenroll in Original Medicare (along with/or another plan) with Blue here to guide and support you along your journey – this truly is Blue’s advantage!