If you’re getting close to 65 years old, you may be wondering about Medicare. With the recent announcement of improvements to Medicare Part D, many are likely wondering how Medicare works in the first place, whether or not they qualify, and what “Part D” even means.
Read on to learn more about Medicare, and how you can receive its benefits.
What is Medicare?
Medicare is health insurance specifically made available for people who are 65 years and older. Recipients may be retiring, and losing the health insurance received from their employer. They could still be working, but perhaps their employer’s provider does not meet their needs, or is unable to sufficiently lighten the financial burden of their medical expenses.
In any case, Medicare is designed to help older adults receive and afford the health care they require. It is also available for individuals who have various disabilities, End-Stage Renal Disease, or ALS (Lou Gehrig’s Disease).
How do I receive Medicare?
If you are planning to receive retirement benefits when you turn 65, you will have applied at least 4 months prior to your birthday for Social Security benefits (or the Railroad Retirement Board). In doing so, you will be automatically enrolled in what’s called “Original Medicare.”
However, there is an increasing number of people who will not receive Social Security benefits when they reach 65. Social Security benefits are based on your lifetime earnings in Social-Security-covered employment. So for people with employment patterns that don’t fit this description, or people like late-life immigrants who have not been employed in the United States for very long, Social Security benefits may not be an option.
Until this is amended on a policy level, folks without these benefits will need to apply for Medicare, and receive a plan based on their income and expenses. You can do so via medicare.gov or by calling 1-800-MEDICARE. If you require assistance, please consider the NHCOA Resource Center Hotline, at 202-658-8864.
What does a Medicare Plan Look like?
There are four ‘parts’ of Medicare that recipients may receive a combination of. Retirees are automatically enrolled in what is called “Original Medicare,” which is a combination of Parts A & B. Many recipients also choose to enroll in Part D, as an addition to their plan. Part C is known as “Medicare Advantage,” and is a bundled plan that includes Parts A, B, and D.
Part A, Hospital Insurance:
This aspect of a Medicare plan is responsible for all manners of inpatient care. This is the insurance used when an enrollee requires stay in a hospital, skilled nursing facility, or hospice; it may even cover instances of home health care.
Part B, Medical Insurance:
Routine measures of healthcare like various appointments with doctors and healthcare providers are covered in Part B, along with screenings, vaccinations, and general “wellness” visits. It also includes any equipment necessary to an enrollee’s condition or treatment, like wheelchairs and more.
Part D, Drug Insurance:
Part D was created to account for high costs that have become common in prescription drugs. Enrollees may be prescribed a medication/drug that is quite expensive, and being enrolled in Part D helps to curb the financial burden of these prescriptions.
This aspect of Medicare was recently improved to help enrollees manage their finance with a payment plan option and a cap to out-of-pocket costs. Read more about these improvements in our previous blog post, here.
Part C, Medicare Advantage:
The primary difference in enrolling in Medicare Advantage, as opposed to Original Medicare, is that your plan comes from a Medicare-approved private company. This approved company covers a bundle of Parts A, B, and usually D.
Medicare Advantage, can be quite advantageous, but it requires some adaptability. You will likely need to find a Primary Care Provider that is within the plan’s network, meaning if you had a previous PCP, they may not take your new plan. The out-of-pocket costs are also likely to differ from Original Medicare, as well as across different Medicare Advantage Plans. You will need to shop around and find the correct provider and plan that fits your needs, but it may be worth it as Medicare Advantage plans may offer additional benefits that are not seen in Original Medicare.
Medigap, Medicare Supplemental Insurance:
This is an additional option available to those who are enrolled in Original Medicare. It was created with the intention of helping certain enrollees with the costs that come with Original Medicare. If their share of the costs places a financial burden on them, or that they simply cannot afford, they may buy into extra insurance from a private company that will help pay your share of Original Medicare.
Important Reminders:
– Any form of Medicare will pose certain costs to the enrollee.
– Premium-free versions are available, but are subject to certain qualifications, including that the enrollee be receiving Social Security benefits.
– If you are not receiving Social Security benefits, you must apply to Medicare; it will not be automatic.
– Medicare plans cannot be extended from the enrollees to their spouse or family members; all plans are for individuals.
– When enrolling in Medicare, it’s important that you know what your specific needs are, such that you can find the perfect plan for you that is both affordable and effective.
References:
– “Get Started with Medicare,” Basics. Medicare.gov. https://www.medicare.gov/basics/get-started-with-medicare
– “How does Medicare work?” Medicare Basics. Medicare.gov. https://www.medicare.gov/basics/get-started-with-medicare/medicare-basics/how-does-medicare-work
– “Parts of Medicare,” Medicare Basics. Medicare.gov. https://www.medicare.gov/basics/get-started-with-medicare/medicare-basics/parts-of-medicare
– “Original Medicare Eligivility and Enrollment,” Medicare. Medicare.gov. https://www.cms.gov/medicare/enrollment-renewal/original-part-a-b
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