About 64 million Americans or 18.4% of the population have access to Medicare.
Unfortunately, most Medicare recipients still have to make larger out-of-pocket purchases of drugs or additional services. You can save hundreds of dollars annually if your insurance covers these costs.
How do you choose the best Medicare suited for you? Keep reading to get valuable insights on how to choose a medicare plan.
What is Medicare?
First, Medicare, also known as Original Medicare, is a federal government health insurance program for those with final-stage renal illness, disabilities, and seniors aged 65 and over.
Medicare offers several options that provide coverage for various medical conditions. Some of these plans come at a cost just like private insurance.
How Does Medicare Work?
Medicare is a U.S. government initiative to provide coverage to persons without insurance. It was established in 1965 under the Social Security Act, and the Centers for Medicare and Medicaid Services((CMS) manage it.
Medicare consists of four plans: Parts A, B, C, and D. Enrollment in Parts A and B is mandatory as long as you receive social security benefits.
Part D is optional and participation is voluntary. Private insurance companies provide Part C plans, also referred to as Medicare Advantage plans.
When you sign up for Part C, you’ll receive additional coverage in addition to the Original Medicare coverage. If you already have Medicare Parts A and B, you can enroll for Part C.
You may be eligible for Medicare if you are over 65 and currently receiving Social Security Disability Insurance (SSDI).
If you’re receiving SSDI, you must wait two years before becoming eligible after getting your first paycheck. Notably, a premium waiver is available to those suffering from renal failure or other forms of disability.
Part A is free of charge if you or your spouse have paid employment taxes into Medicare for more than ten years. Other Medicare parts, however, need premium payments to stay active.
How Do You Sign Up For Medicare?
At the age of 65, you’re automatically enrolled in Medicare Part A. While Part B covers medical visits, Part A only covers hospital costs.
You don’t need to register to access Part A and B of the Medicare program because enrollment is systematic.
Part D provides prescription drug coverage and you can join via the Social Security Administration website. You can join the plan during the seven-month window surrounding your 65th birthday.
Also, it can be three months to your birthday or after your birthday. Failing to enroll at this time may lead to penalties.
Is Medicare the Same As Medigap?
Medigap is not the same as Medicare, but a supplemental insurance policy you can get from a private insurer to pay for costs not covered by Medicare.
Examples of these costs include deductibles, co-payments, and medical expenses incurred during travel abroad. However, the policy doesn’t cover dental, vision, and long-term care.
Medigap is voluntary; you can sign up when you turn 65 years old and are already enrolled in Medicare Part B.
What Does Medicare Plans Cover?
The scope of coverage depends on the specific Medicare plan.
Part A covers expenses incurred for health care, including inpatient costs, skilled nursing care, home-based care and hospice. But the policy excludes long-term custodial care.
The U.S. Centers for Medicare and Medicaid Services provides the deductible and co-payments amounts for Part A.
Here’s a coverage structure for 2022.
|Daily co-insurance from 61 to 90th Day
|Daily co-insurance for lifetime reserve days
|Skilled nursing facility coinsurance
Medicare Part B covers doctor visits, ambulance services, preventive services, mental health coverage, and certain medical equipment. You may also get some prescription drugs under this policy.
Currently, the monthly premium is $170.10, and the annual deductible is $233. If your income is more than $88,000, your premiums will be higher.
Part C or Medicare Advantage is offered by private insurance and has annual limits of out-of-pocket expenses and deductibles. Some plans cater for costs incurred if you’re out of the country, as well as hearing, dental, and vision care.
Part D allows individuals to get prescription drugs at lower costs. It’s also supplemental coverage.
Is There a Difference Between Medicare and Medicaid?
Even though both Medicare and Medicaid are federal government health insurance plans, they have different eligibility requirements. Medicare is for people aged 65 years and above, people with chronic kidney problems, and young people living with a disability.
On the other hand, Medicaid is a federal and state program providing healthcare coverage to low-income citizens. With Medicaid, you can pay for doctor appointments, nursing care, and X-ray.
It also covers lab services, hospitalization, and home health care. Some states may have supplemental coverage, including drugs, dental, ambulance, dental and physiotherapy services.
What Are the Medical Services Not Covered by Medicare?
Even though Medicare covers most health services, some are not covered by the policy. These include cosmetic surgery, massage therapy, dental care, eye exams, dentures, and cosmetic dentistry.
Tips When Choosing Medicare Suited For You
Now that you understand what Medicare entails, you can use the following tips to decide on the best policy.
- It’s important to know about the premiums, co-pays, deductibles and coinsurance.
- Understand how each plan works and the scope of coverage.
- Know where to get prescription drugs at discounts if you can’t afford Medicare Part B.
- Know the type of benefits you need and decide on the best Medicare plan for you.
Medicare plans benefit seniors, people with disabilities, and those with renal problems. Medicare Part A is free, but B, C and D require participants to pay a premium. It may burden seniors and those requiring long-term hospitalization and care. Finally, you should understand your specific personal health needs when choosing the right plan.