You may now be eligible for Medicare, but the number of plans out there can be overwhelming.
How do you know which one is best for you?
What makes sense for your health needs, and how do you even go about applying for Medicare?
Below, you’ll find the answers to every question you’ve ever had about Medicare, their different plans, and your eligibility.
What Is Medicare?
Medicare is a government-run program that provides health insurance for those aged 65 or older. Original Medicare can be broken up into two parts, Part A and Part B. Part A covers hospital insurance and Part B covers medical insurance.
If you have Original Medicare you pay for services as you get them, and when you use these services you pay a deductible at the beginning of each year.
This is often 20% of the cost of the service, and the service needs to be Medicare-approved. This is called coinsurance. There is also a Part D of Medicare, and this is a drug plan that you can sign up for separately.
While original Medicare covers most of the cost for the health care services and supplies, it doesn’t pay for all of it. However, there are services that can supplement this.
For example, the Medicare Supplement Insurance (Medigap) policy can assist you in paying some outstanding health care costs, like coinsurance, co-payments, and deductibles.
Medigap also comes in handy if you need emergency medical care abroad. Some Medigap policies provide this, while Original Medicare doesn’t cover this at all.
Who Is Eligible For Medicare?
You are generally eligible for medicare if you are aged 65 or older. However, younger people with disabilities and those with End-Stage Renal Disease can also be eligible for Medicare. Those with End-Stage Renal Disease have suffered permanent kidney failure and require dialysis or a kidney transplant.
How To Apply For Medicare
Applying for Medicare is fairly straightforward, and you can apply via their website or with the assistance of an agent at no cost to you.
Most Medicare customers sign up for Parts A and B when they reach the eligible age, i.e. 65. It is recommended that you apply for Medicare as soon as you’re eligible, to avoid gaps in your coverage, as well as a penalty. However, sometimes it makes sense to sign up for Medicare at a later date.
There is a 7-month Initial Enrollment Period that gives you plenty of time to sign up, and if you miss this period you will need to pay a monthly late enrollment penalty for the duration of your Part B coverage.
The longer you wait, the more your penalty increases, so it’s important not to delay! If you pay a Part A premium, you may also need to pay a penalty.
The date your coverage starts will depend on when you signed up during your Initial Enrollment Period. However, coverage normally begins on the first of the month. But if you’re eligible for premium-free Part A, then this coverage will start the month of your 65th birthday!
However, if your birthday falls on the first of the month, then your coverage will begin the month before your birthday.
However, Premium-Part A and Part B coverage start according to what month you sign up. So if you sign up the month before you turn 65, then the coverage will start a month later.
However, if you sign up during the month you turn 65 then your coverage will start the following month, if you sign up a month after your 65th birthday your coverage will start 2 months after you sign up, and if you sign up a 2-3 months after your 65th birthday then your coverage will begin 3 months later.
What Is Medicare Part A?
Different parts of Medicare cover specific services and Medicare Part A covers hospital insurance. Hospital insurance covers any visits to the hospital, hospice care, any care you receive in a skilled nursing facility, and even some care at home.
If your spouse paid Medicare taxes while working for a certain amount of time, you may not need to pay a monthly premium for Part A. This is often referred to as ‘premium-free Part A.’ However, if you’re not eligible for premium-free Part A, then you can always buy Part A.
What Is Medicare Part B?
Medicare Part B covers Medical Insurance, so this means medical supplies, preventative services, outpatient care, and also certain services doctors provide.
Most Medicare customers will pay the standard amount for Premium Part B. But if your modified adjusted gross income reported on your IRS tax return form from two years previously exceeds a certain amount you will pay the standard premium amount.
And an Income Related Monthly Adjustment Amount, or IRMAA, and is an extra charge that is added to your premium.
What Is Medicare Part C?
Medicare Part C is also known as the Medicare Advantage Plan. It is a plan created by a private company and approved by Medicare and is an alternative to Original Medicare. These plans are sold as bundles incorporating Part A and B and some of Part D.
These plans may provide extra benefits that you wouldn’t find in Original Medicare, such as dental services, hearing services, and vision services.
Medicare Advantage Plans are contracted by the year and must adhere to the rules of Medicare coverage. This includes notifying you about any changes to your plan ahead of the next enrollment year.
What Is Medicare Part D?
Medicare Part D covers the cost of prescription drugs, and this includes many recommended vaccines. To get this kind of coverage, you will need to join a plan that is approved by Medicare that offers drug coverage, such as Medicare drug plans and Medicare Advantage Plans that also cover the cost of prescription drugs.
Each plan is different in both cost and what types of drugs are covered. But all plans must offer a standard level of coverage that is set by Medicare. The drugs covered by these plans can include generic as well as name-brand drugs.
The list of prescription drugs provided by a plan are called formularies, and these lists can vary, and drugs can be placed in different tiers.
Part D plans also have monthly premiums that can vary. You will also have to pay other costs throughout the year with a Part D plan, and how much you pay for each prescription drug will differ according to the plan you’re with.
What Is A Medicare Advantage Plan?
A Medicare Advantage Plan is also known as Medicare Part C.
Unless you are receiving benefits from Social Security or a particular disability benefit, you will need to sign up for Medicare Part A, Medicare Part B, or both.
But with Medicare Advantage, you need to pay a premium for Medicare Part B, but these benefits are lumped together in a single plan that is handled by a Medicare-approved, private insurance company that has a contract with the federal government.
Some Medicare Advantage Plans also offer prescription drug coverage.
Pros Of A Medicare Advantage Plan
Medicare Advantage plans are incredibly popular at the moment and for good reason. Having a single plan that covers every aspect of your health plan feels like a familiar plan to wrap your head around.
It has a similar structure to benefits you may have received whilst in employment. Medicare Advantage Plans vary in terms of the benefits they provide and their cost, but may offer extra coverage for things like dental and vision.
Cons Of A Medicare Advantage Plan
If you are interested in a Medicare Advantage plan there are a couple of things to consider. You may need to receive a referral from your primary care provider for an appointment with a specialist, like a dermatologist or a rheumatologist in order to be eligible.
Plus, a Medicare Advantage Plan can limit the number of specialists you can see, as you may need to visit health care providers that are in their network.
How To Sign Up For Medicare
You can sign up for Medicare without an account! After you have signed up and received your Medicare you can create a secure and safe Medicare account.
To get more coverage you can join a plan or buy supplement insurance. However, you can only sign up for Part B, or Part A if you need a premium at certain times. You can speak to a licensed Medicare agent who can explain this in more detail.
Speak With A Licensed Medicare Agent And Schedule A Phone Call Or Zoom Chat
You are usually eligible to sign up for Medicare 3 months before your 65th birthday, and once you are eligible you have two options. You can sign up to just get Medicare coverage, or you can apply to start receiving benefits from Social Security, or the Railroad Retirement Board.
Once these have been approved, you will automatically receive Part A coverage, and you can choose whether you want Part B coverage when you apply for these benefits.
Once you’re signed up your benefits are approved you will receive a Medicare welcome package and a Medicare card.
Frequently Asked Questions
What Is The Difference Between Medicare And Medicaid?
While Medicare and Medicaid are both run by the federal government, they are two separate programs. They are funded and operated by different branches of the government and are focused on supporting two different groups with their healthcare.
Medicare provides health coverage if you’re over the age of 65, or if you’re under 65 and have a disability, regardless of your income. However, Medicaid is a federal and state program that provides health coverage to those on a very low income.
While Medicare and Medicaid are different programs, if you are eligible for both then you can receive both to help lower the costs of your health care.
Why Are Medicare Advantage Plans Bad?
While Medicare Advantage Plans work for some, they’re not for everyone. Generally, Medicare Advantage Plans do not provide the same level of choice as Medicare with a Medigap supplement.
We already mentioned that with some Medicare Advantage plans you are limited to a network of doctors and health providers, which can be problematic for some. Medicare Advantage Plans cannot select their customers or be picky about the customers they sell to.
They are obligated to take on customers who are eligible for Medicare and discourage those with complex health needs by structuring their co-pays and deductibles in a way that doesn’t benefit those who are ill.
How Much Does Medicare Cost?
Most customers don’t pay a monthly premium for Medicare Part A, but if you do buy Part A it will cost around $400-$500, and this is also the case if you paid Medicare taxes for under 30 quarters.
If you paid Medicare taxes for over 30 quarters but less than 40 quarters, then the standard Part A premium is between $200-$300. Meanwhile, the standard Part B premium amount is between $100-$200, but this could be higher depending on your income.
However, the monthly premiums for Medicare Part C (or Medicare Advantage Plan) and Part D vary by plan. Part D customers with a higher income may also pay more.
How Old Do You Have To Be To Get Medicare?
Generally, you have to be aged 65 and older to be eligible for Medicare, but younger people who are disabled, or those suffering from End-Stage Renal Disease may also be eligible.