What you need to know about Medicare. What You Need to Know About MEDICARE. Page 1

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1 What You Need to Know About MEDICARE Page 1

2 Index Introduction Know when to enroll What s medigap? Choosing prescription drug coverage Medicare won t cover certain things Shopping for coverage

3 Introduction Medicare is an insurance program through the federal government that helps people 65 and older, some younger Americans with disabilities and individuals with end-stage renal disease receive coverage for care. Where these people would otherwise be subject to high out-of-pocket health care costs, purchasing Medicare allows them to get these bills covered. A Medicare plan should be tailored to individuals specific needs, therefore what parts they choose matters. However, despite its significant importance, many Americans are unsure of the various parts of Medicare. There are a wide array of plans and options to choose from, and those looking to sign up will have to be diligent when shopping for coverage. A Medicare plan should be tailored to individuals specific needs, therefore what parts they choose matters. Here is a list of parts Medicare shoppers will have to consider: Page 2

4 Medicare Part A: This part of Medicare is known as hospital coverage, as it will cover the expenses for services including in patient care, skilled-nursing care after hospital visits and care at home or in a hospice care center. Medicare Part B: Typically referred to as medical coverage, Medicare Part B pays for expenses like home health treatment, outpatient hospital care, durable medical equipment and supplies, services associated with a clinical laboratory and a number of other health services, including shots, exams and health screenings. Medicare Part C: This part includes coverage beyond Parts A and B and typically includes coverage for prescription drugs. It is referred to as Medicare Advantage. According to Medicare.gov, this plan includes Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans and Medicare Medical Savings Account Plans. Medicare Part D: Seniors can receive prescription drug coverage either through a Medicare Advantage Plan (Part C) or through a Medicare Prescription Drug Plan, commonly referred to as Part D. It can be combined with Medicare parts A and or B or purchased on its own. Know When to Enroll It s possible to enroll in Medicare at any time. There is a period of open enrollment in which it makes the most sense to sign up for coverage or make changes to a plan. The open enrollment period for obtaining Medicare Parts C and D occurs between April 1 and June 30. However, a person who is about to be eligible for Medicare can sign up three Page 3

5 months before him or her turns 65, and this period ends the three months after his or her birthday. Coverage will kick in the first month after individuals have signed up for a plan, but if they joined in any of the three months leading up to their birthday month, coverage will begin on the first day of the month they turn 65. From there, there are two separate periods of enrollment each year where seniors will be able to alter their plans. Here s a list of things they can do during this period of time: Change an Original Medicare plan to a Medicare Advantage plan Switch back from Medicare Advantage to Original Medicare Obtain Medicare Part D for prescription drug coverage Change from one drug plan to another Drop prescription drug coverage altogether There are two separate periods of enrollment each year where seniors will be able to alter their plans. Page 4

6 What s Medigap? Medicare Supplement insurance, also known as Medigap, provides coverage for a number of the copayments and some coinsurance costs related to health care services. Here are some of things a Medigap policy will help pay for: Care at a hospital Skilled nursing care At-home health services Emergency ambulance transportation Doctor charges Durable medical equipment Medigap provides coverage for a number of the copayments and some coinsurance costs related to health care services. Individuals must be enrolled in Medicare parts A or B before they can sign up for Medicare Supplement coverage. During the period of open enrollment, a person will not be required to have a medical screening. However, in the time outside of the open enrollment period, an insurance company could require a medical screening. Choosing Prescription Drug Coverage People over 65 should be diligent in researching Medicare Part D, making sure the medications they want are covered or even investigating similar medications at a cheaper price. Seniors will still have copayments and coinsurance to have their prescriptions filled. While these costs will be small, they are still important to be aware of. Coverage could cost anywhere from just the plan s premium to around $70 in additional Page 5

7 expenses. This part of Medicare is designed to lessen the financial burden of prescription medication on seniors, and that is just what it will do. Medicare Won t Cover Certain Things While Medicare provides comprehensive care coverage, there is certain care it will not pay for. It s equally important seniors are aware of the care Medicare doesn t cover as well as the services it does cover. Medicare won t cover long-term care services. However, someone with Medicare Part D who is in a nursing home will still have medical care coverage, it just won t pay for the other nursing care costs. Here are the other services Medicare won t cover: Care from a private-duty nurse Homemaker services Most dental and denture care Eye care, glasses and hearing aids Cosmetic surgery Health care provided out of the country Page 6

8 Shopping for Coverage When it comes to finding the right Medicare coverage, seniors are not alone. Licensed agents are available to help individuals find the coverage they need, providing them with a number of services, including: Answers to any of their questions about Medicare Help with making a more informed decision based on all the options Comparisons of options within Medicare Supplement, Advantage and prescription drug plans Anyone signing up for Medicare would be well served to find the best help possible. Instead of someone having to tediously compare the coverage and various options of Medicare from one insurance provider to another, licensed agents will do all the work. These professionals can efficiently compare the plans of more than 20 A-rated insurance providers to find individuals an affordable price and the right coverage. From narrowing down specific needs to finding the ideal price point, anyone signing up for Medicare would be well served to find the best help possible. Page 7

9 Sources money.cnn.com/retirement/guide/insurance_health.moneymag/index16.htm whats-medicare/what-is-medicare.html when-can-i-join-a-health-or-drug-plan.html

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