Are you approaching age 65? Are you wondering if it’s time to think about Medicare?
Medicare provides health coverage for those who would otherwise go uninsured. It comes with a very low monthly fee and usually benefits seniors as well as those with disabilities.
What are the parts of Medicare, and what do you need to meet your basic medical needs?
Let’s take a look at Medicare 101.
Table of Contents
1. What Is Medicare?
Medicare is a federal health insurance program for those over age 65, younger people with certain disabilities, and those with permanent kidney failure.
You can apply for Part A of Medicare three months before your sixth-fifth birthday. You’ll need, however, to meet certain eligibility requirements.
These requirements include receiving retirement benefits from Social Security or the Railroad Retirement Board. You’re also eligible if you or your spouse had Medicare-covered government employment.
You may still be eligible to buy into part A if you or your spouse didn’t pay Medicare taxes while you worked. You’ll need to be a citizen or permanent resident of the United States.
2. Medicare Part A
You may get Medicare Parts A and B automatically, or you may need to sign up for them.
Medicare Part A is designed to pay for hospital stays. It will generally cover skilled nursing care, inpatient stays, and hospice care. Part A may also provide you with limited coverage for home health-care stays.
If you or your spouse paid a premium for Medicare for a certain amount of time while you were working, you probably won’t need to pay a premium for Part A.
If, however, you don’t qualify for a premium-free Part A, you can still buy into it. Your premiums could be anywhere from $252 to $458 each month.
3. Medicare Part B
Medicare Part B helps to pay for services from healthcare providers and doctors that don’t involve hospital visits. This could include preventative services, medical equipment, and home health care.
You will pay a small premium each month for Medicare Part B. It will get automatically deducted from your benefit payments if you receive benefits from the Social Security Administration, the Railroad Retirement Board, or the Office of Personnel Management. If you aren’t receiving benefits from one of these entities, you’ll get a traditional bill in the mail.
The standard monthly premium for Medicare Part B coverage is $144.60 as of 2020.
4. Medicare Part C
Medicare Part C plans are also known as Medicare Advantage plans. They are offered by private companies that get approved by Medicare.
Advantage plans cover additional healthcare services that aren’t included in Parts A and B. These include vision, dental, and fitness programs. They may also cover things like over-the-counter medications and transportation to your doctor visits.
If you join a Medicare Advantage plan, it gets “bundled” together with your other Medicare plans.
Many of the Medicare Advantage plans don’t have a premium. Some plans will also pay for some or part of your Part B premium. You may also need to pay a small co-pay when you visit your doctor.
When considering Advantage plans, you’ll want to find out if there’s a yearly deductible.
5. Medicare Part D
Medicare Part D covers prescription drugs. You will likely need to pay a monthly fee. Premiums are generally low, but they’ll vary depending upon your income.
If you’re enrolled in Medicare Advantage, the monthly premium you’re paying may include drug coverage.
6. Medigap Policies
Medigap policies, such as Medicare Plan G, are provided by private health insurance companies to help fill the “gaps” in your regular Medicare coverage. They can cover things like copays, coinsurance, and deductibles.
Some Medigap policies will also cover you when you travel outside the U.S., a service that isn’t covered by traditional Medicare.
Medicare Plan G is one of the most popular supplemental plans. It pays for your Part A deductible and hospice coinsurance, Part B coinsurance, and Part B excess charge. Part G will also cover up to 80% of the medical care you get while traveling outside the country.
The Right Medicare Plan For You
When you first apply for Medicare, there will be a number of things to consider before choosing options like Medicare Advantage and Medigap.
One of the things you’ll want to think about first is the doctors you’re currently seeing and whether or not they’ll be covered with different Medicare options. If you’re open to finding another in-network physician, you may be able to shop around a little more.
You’ll also want to find out what would happen if you visit a physician who’s out of network. In some cases, you may simply have a higher co-payment and out-of-pocket maximum. In others, however, you may not get any out-of-network coverage unless it’s an emergency.
You’ll never know what all of your healthcare needs could be from year to year. You may, however, be able to count on certain expenses, such as regular visits to specialists. You’ll need to consider how these visits will get covered under Medicare.
Your drug coverage is also something you should plan carefully before signing up. A plan may offer low-premium policies with certain preferred pharmacies. If you get regular prescriptions, make sure you can find one that’s on the list in your area!
Medicare 101
When you first become eligible for Medicare, the options may seem overwhelming. With a little research into Medicare 101, however, you could be on your way to finding the perfect plan for you in no time!
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