A hospital stay can cost almost $ 4,000 per day in the USA. So, it’s easy to see why health insurance is a top priority for citizens of all ages, especially as they reach retirement age.
Tha’s because, as you age, your medical needs are bound to increase at a time when you can least afford it.
Fortunately, the federal government has a plan for all Americans over the age of 65.
Medicare is a life-saver for many citizens, yet some aspects of this system are still shrouded in mystery.
Take a look at these common Medicare questions to help you find out more about this type of health insurance and how it can help you.
What is Medicare?
At face value, Medicare is a simple health care plan that caters to the most common medical needs of all US citizens over the age of 65.
It has two main parts known as Original Medicare. These are:
- Medicare Part A which covers inpatient hospital stay, nursing facility care, and limited home health care
- Medicare Part B for medical supplies, preventive care, outpatient treatment, and some doctor’s services
There are also two parts of Medicare offered by private insurers. These are:
- Medicare Part C or Medicare Advantage Plans
- Medicare Part D for prescription medications
- Medigap policies and supplemental health insurance
These privately offered health insurance plans must still comply with certain inclusions according to federal law but they can offer extra benefits too. Usually, these come with extra costs.
Some insurers offer basic Medicare Advantage plans free of charge.
Although you buy Medigap plans from private insurers, they’re strictly regulated and controlled by federal and state laws.
Is Medicare Mandatory?
Medicare isn’t mandatory, but it’s a necessity to ensure you’re cared for in the event of serious illness or injury.
Also, if you pay towards Medicare throughout your working life, you’re entitled to premium-free Medicare Part A, so there’s no reason not to take it.
If you aren’t entitled to free Medicare, you can decline it in favor of a Medicare Advantage plan. However, you’ll face penalties if you change your mind later and decide to go back to Medicare after the initial enrolment period.
When Do I Need to Enrol For Medicare?
Technically, you can sign up for Medicate anytime. However, you’ll have to pay higher premiums if you choose to do this.
You could also face some exclusions or waiting periods depending on pre-existing health conditions. So, it’s important to pay attention to these important enrollment periods:
Medicare Initial Enrollment Period
To avoid penalties you must sign up for Medicare within the seven-month window around your 65th birthday. This time frame extends from three months before your birthday month, spans the month of your birthday, and ends three months afterward.
Once you’ve signed up for original Medicare you can enroll in a Medigap plan for six months after the first day of the month you turn 65 without penalties.
Special Enrolment periods
You can also sign up for Medicare within certain time frames if you can no longer use your existing health care for any reason. For example, if your employer’s health insurance coverage ends or you move to another state.
These time frames vary according to the specific circumstances.
Open Enrolment for Supplement Plans
If you missed the initial enrolment period, and don’t qualify for a special enrolment period, you have one more chance to sign up for Medicare supplement plans penalty-free.
This time frame extends from January 1 to March 31 every year. You can also switch plans during this time period.
Medicare Billing Questions
One of the most common Medicare questions is, ‘How much does Medicare cost?’. There are a few answers to these questions.
If you paid towards Medicare as part of your taxes for more than 40 months while employed, you don’t pay for Medicare Part A for the rest of your life. Most people fall into this category
Those who paid for less than 30 months will need to contribute $458. If you paid for 30 to 39 months, your premium is $252.
Medicare Part B currently costs $ 144.60 or more depending on your income. Private insurers have their own pricing for policies they offer under Medicare Part C and D, as well as Medigap.
With Original Medicare, you’ll also have to pay deductibles and coinsurance costs for certain treatments.
You’ll receive a Medicare Summary Notice every three months detailing any treatments you’ve received and how much Medicare paid towards these. You’ll need to settle the balance with your medical service providers.
To avoid these extra costs, it’s a good idea to take out a Medigap policy. Read this article for more information about choosing a Medigap plan that’s right for you.
Medicare Coverage Questions
Medicare’s designed to save costs so that more people can benefit. As such, it covers only the most essential medical services.
These are some of the things that aren’t covered by Original Medicare:
- Cosmetic surgery
- Eye examinations related to prescription glasses
- Most dental care
- Hearing aids and examinations for hearing aid fittings
- Routine foot care
- Self-administered drugs
- Prescription medications
Also, it’s important to note that most Medigap plans also have exclusions, especially when it comes to out-of-state cover and international travel. About 90% of people signed up for Medicare opt for supplemental plans to cover their extra costs.
Medicare Advantage plans offer more extensive cover but this comes with higher monthly premiums. Sometimes, Advantage Part C plans work out cheaper when you consider the cost of coinsurance and deductibles.
What is Medicare Part C?
Most of the questions you’ll face when deciding on your healthcare options revolve around how much bang you’re getting for your buck.
For many citizens, Medicare covers most of their needs at an affordable cost. However, if you need additional peace of mind or additional coverage, you might need something more.
This is where Medicare Part C plans come in. These plans cover a varying range of extra treatments, preventive healthcare measures, and convenient extras.
The plans vary widely, but these are the basic things to know about Medicare Advantage plans.
What Extra Services Does Medicare Part C Cover?
Most Advantage plans pay for services like hearing, vision, dental, and fitness benefits. Some include prescription drug coverage too.
Apart from the legally-prescribed basics, insurers may provide extra healthcare coverage as they see fit.
The major drawback of Medicare Advantage plans is that they only work with a limited pool of in-network doctors. You’ll pay extra if your doctor or hospital isn’t included in this network of health providers.
How Do I Get a Free Medicare Advantage Plan?
Amazingly, about half the people enrolled in Medicare Advantage plans pay no monthly premium. You will have to pay coinsurance, deductibles, and co-payments with these plans and you still need to pay Part B premiums.
It’s easy to see how these zero-premium plans can work out more expensive in the end. One benefit of these is that you won’t have to pay anything unless you fall ill.
If you’re a low-income person and you’re eligible for Medicare, you could apply for Medicaid.
This type of health insurance doesn’t have any premiums, copayments, or deductibles. It also covers some things that Medicare doesn’t like routine dental and vision services.
Types of Medicare Advantage Plans
There are four main types of Medicare Part C plans. These are:
- PFFS or Private fee-for-service plans offering a flexible range of service providers
- PPO or Preferred provider organization plans which cover out of network services at an elevated rate
- HMO or Health maintenance organization plans which allow services from in-network providers and doctors only
- SNP or Special Needs plans for people with long-term health conditions
Other options may include medical savings plans and HMO point of service plans.
What’s Included in Medicare Part D?
Medicare Part D only covers the cost of prescription medications.
All Part D plans have a prescribed list of drugs that they must include in their coverage. These include a wide range of common medications as well as several drugs in protected classes. These include drugs to treat HIV/AIDS and cancer.
All insurers must provide their enrollees with a formulary list of these drugs. They’re entitled to change this list as scientists discover new, more effective treatments for diseases.
All drugs fall into certain tiers according to their price. The higher the tier of drug you need, the more you’ll pay for your Part D premium.
Which is Better Medicare or Medicare Advantage?
The answer to this question depends entirely on your medical needs versus your budget. So, it’s important to compare what you can expect to pay for copayments and deductibles versus your premiums.
The last thing you need to worry about in your later years is medical bills.
Unfortunately, there’s no way to avoid age-related illnesses, so health insurance is vital at this stage of your life. Take care to ensure you’re thinking in the long term when deciding on your options.
These are the questions you need to ask yourself before you make your choice:
- How much can I afford to pay for my monthly premiums?
- Can I afford the cost of copayments when necessary?
- Do I need coverage for prescription medication and doctor’s appointments?
- What are Medicare’s limits and can I afford to pay the shortfall?
- Do my preferred medical suppliers accept Medicare?
- Do I want cover for dental, vision, and hearing treatments?
- Can I afford to pay for necessary prescription medications?
- Do I travel often enough to warrant taking out extra cover?
Once you’ve got concrete answers to all of these issues, it’s a lot easier to make an informed choice.
Medicare Questions to Ask Your Doctor
When you know what questions to ask about Medicare it’s a lot easier to choose the right combination of plans for you.
Your doctor knows your health best, so they can assist you in predicting your future health needs. Besides, they probably deal with hundreds of Medicare patients every year, so they’ll know what the most common requirements are for these patients.
Some of the topics to discuss with your doctor include:
- Whether prescription medication cover is a good idea for you
- What preventive care can you use to avoid serious problems as you age
- Are there generic varieties of medications you’re currently taking?
Remember, choosing the ultimate Medicare solution for our needs is time-consuming. Things can also get complicated when you want to make changes later on.
Rather take time researching all your options carefully and matching them to your needs at the outset.
One of the most important things to discuss with your doctor is whether they accept Medicare insurance or if you’ll need an Advantage plan to continue seeing them in the future.
If you have any Medicare claim questions, it’s a good idea to discuss them with your doctor’s admin office at this time too.
You’ll find answers to most of your Medicare questions on the official Medicare website.
Beyond Medicare Questions
Now you can face your 65th birthday with no worries about Medicare questions.
The best healthcare plan you can have is one where you avoid the need for medical care in the first place. Preventive care can help ensure you enjoy a healthy, happy, and worry-free retirement.
Do you need more answers about securing your ongoing well-being?
Keep browsing the health section of our blog for answers to all of life’s little mysteries and more.