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What is Medicare?
Medicare is the United States federal health insurance program that provides eligible Americans with affordable health care. Through the Medicare program, beneficiaries can get subsidized treatments, medicine, and medical services.
If you are an American citizen who is 65 years of age and older, a young person with disabilities, or have End-Stage Renal Disease (ESRD), you can enroll in Medicare.
Find out what Medicare is, how to apply, what is covered by the different plans, and how you can benefit from enrolling.
When it comes to choosing a Medicare health plan, it can become confusing. Which program is right? Which one covers prescription drugs? Or even, what type of Medicare plans are there?
How Does Medicare Work?
When you enroll in Medicare, you receive a Medicare card tied to your Social Security number that allows you to receive medical services, tests, treatment, and drugs at discounted rates.
Once you enroll, you can access Medicare benefits at public health facilities and approved Medicare providers anywhere in the country.
As a Medicare enrollee, some of the benefits you’ll get, include:
Certain preventative services for free.
80% coverage of your approved Part B expenses.
Coverage for up to 60 days of hospital care before you pay.
Coverage for approved durable medical equipment (DME).
Enrolling in the federal health program is a great move to lower your health care costs and manage your quality of life as you get older.
What Are the Parts of Medicare?
People have unique health care requirements and Medicare is set up to ensure that they get the coverage they need.
There are four parts to Medicare that cover different types of medical costs and treatment.
Medicare Part A covers hospital and inpatient care.
Medicare Part B covers outpatient treatment and preventative care for enrollees.
Medicare Part C, or Medicare Advantage, is private health insurance for seniors with the same coverage as Original Medicare along with some added benefits.
Medicare Part D covers self-administered prescription medication.
There are also different types of coverage options for Medicare-eligible individuals. Let’s take a look at them:
Original Medicare is government-run and covers Medicare Part A and Part B expenses.
Medicare Advantage is private health coverage for seniors that covers Part A, Part B, and, in some cases, Part D expenses. These plans offer additional benefits such as Medicare flex cards and access to gym memberships (SilverSneakers).
Medicare Supplement Insurance or Medigap helps pay for out-of-pocket costs not covered by Original Medicare.
Stand-Alone Prescription Drug Plans or Part D Plans will help you pay for prescription medication costs that aren’t covered by Medicare.
If you want to learn more about the different parts of Medicare, be sure to read our latest guides.
Learn more about your health care options with PolicyScout’s Guide to Medicare Part A.
Learn More about Your Health Care Options with PolicyScout’s Guide to Medicare Part B.
Find out about costs, benefits, and enrollment with our 2022 guide to Medicare Advantage and see if it's right for you.
Is Medicare Coverage the Same for Everyone?
If you’re on Original Medicare, you can expect the same level of care and treatment anywhere in the U.S. Medicare Advantage Plans provide the same level of coverage as Original Medicare and usually offer additional benefits like dental, vision, and hearing cover.
If you decide to get private Medicare coverage through a Medicare Advantage Plan, there are additional costs you’ll need to pay on top of your Original Medicare expenses.
Your monthly premiums will depend on the type of plan you buy and the benefits offered.
If you’re interested in finding an affordable plan in your area, be sure to reach out to one of our agents and use our Medicare plan finder.
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Read PolicyScout’s guide to weight loss surgery and learn how Medicare helps with coverage.
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What Are Medicare Supplement Plans (Medigap)
Medicare Supplement Plans, also known as Medigap, are additional coverage options available to people with Original Medicare.
Medigap helps Medicare beneficiaries with costs that Medicare Parts A and B won’t cover, like coinsurance, co-payments, and most out-of-pocket costs.
Medigap policies are sold by private insurance companies to help with Original Medicare costs. If you have Medicare Advantage, you are not eligible to enroll in Medigap.
In most states, Medigap, or Medicare Supplement Insurance offers standardized plans that cover the same costs. Each plan can be identified by a letter: A, B, C, D, F, G, K, L, M, and N.
However, Wisconsin, Minnesota, and Massachusetts have their own versions of Medicare Supplement Insurance. If you want to find out more about Medigap plans in your area, start with our state-specific guides.
Find out about Medicare Supplement Plans, how they work, the eligibility requirements, and how much a policy could cost you.
Learn about Medigap (Medicare Supplement Insurance) and Medicare Advantage to find out which one is right for you.
Medicare is open to all U.S. citizens and legal residents who are 65 or older. You are also eligible for Medicare at any age if you get Social Security disability benefits, or if you suffer from ESRD (End-Stage Renal Disease) or ALS (Lou Gehrig’s Disease).
You will automatically be enrolled in Original Medicare when you turn 65 if you are already receiving Social Security benefits.
To be eligible for premium-free Medicare Part A at age 65, you must meet the following requirements:
You or a spouse has/had Medicare-covered government employment.
You or a spouse had worked for 10 years to qualify for social security and paid Medicare taxes.
You are receiving retirement benefits from Social Security or the Railroad Retirement Board.
Read our latest guides and articles to find out more about Medicare eligibility.
Learn about the age-related and disability-related requirements for Medicare eligibility.
Find out what it means to be dual eligible and whether you should apply.
As a general rule, eligibility for Medicare begins at 65, and many employees continue on their employer’s medical plan at retirement until they reach this age. But, there are certain situations in which you might be eligible for Medicare benefits before the age of 65.
Learn about qualifying for Medicare Part A, B, C, and D
Medicare Enrollment Periods
It's important to review your Medicare health and drug coverage and make changes if it doesn't meet your needs. Even if you’re happy with your current plan, you should stay up to date on your options.
If you are eligible for Medicare, here are the key enrollment periods to keep in mind:
Your initial enrollment period (IEP) starts three months before and three months after your 65th birthday month. There may be late enrollment fees if you do not enroll during this seven-month window.
Open enrollment period (OEP) is another opportunity to enroll or change plans. The open enrollment period, which runs from October 15th to December 7th, allows you to make free changes or updates to your plan.
General enrollment period (GEP) is for people who are currently enrolled in a Medicare Advantage Plan and want to change plans or return to their Original Medicare plan. Each year, the GEP starts from January 1st to March 31st and any changes will reflect on the first of the month after they’ve been made.
Special enrollment period (SEP)is when, under certain circumstances, you can change your Medicare coverage outside of IEP, OEP, and GEP. This may be allowed if you are moving states or if your Medicare Advantage provider stops offering coverage.
Learn all about the Medicare Open Enrollment Period and how you can use it to make the most of your Medicare enrollment.
What Are the Costs of Medicare?
Before you join Medicare, it’s important to understand what your monthly costs will be and how much you’ll have to pay before you can access benefits through the program.
There are five types of costs to consider - premiums, deductibles, coinsurance, copays, and out-of-pocket costs.
The Part A Deductible is $1,556 per benefit period.
- 0-60 days: $0 per day.
- 61-90 days: $389 per day.
- 90+ days: $778 per lifetime reserve day.
- After your lifetime reserve days are finished: Full cost.
The Part B Deductible is $233 per year.
After meeting the deductible, you are responsible for 20% of costs of your medical bills.
The average Part B premium is $170.10 and can vary on income level.
Some important things to consider:
For Medicare Part A, most people won’t pay premiums if they’ve paid their social security taxes.
There is no limit to out-of-pocket costs per year if you enroll in Original Medicare.
If you require a significant amount of medical care, consider a Medicare Advantage Plan that has an out-of-pocket limit.
To learn about Medicare costs in more detail, read our latest guides.
Learn about all the costs associated with getting Medicare cover.
Everything you need to know about Medicare out-of-pocket maximums.
Everything you need to know about Medicare tax and its implications.
Learn about veterans administration, Medicare, veteran benefits, and civilian health coverage for former servicemen and servicewomen.
How Do I Buy Medicare?
With over 3,800 Medicare Advantage Plans available in 2022, choosing a Medicare Advantage Plan can be tricky—especially if you’re new to the program.
Here are some tips to keep in mind when looking for Medicare coverage.
Determine how much you want to spend. The first step is deciding how much money you want to spend on health care.
Take note of your current prescriptions, your current health status, and your family health history to help you figure out what kind of coverage you need.
Determine what coverage you need: Make a wish list of conditions and services that are a must-have when you evaluate health care plans.
If you’ve decided on Original Medicare, look at other options that can supplement your coverage. Medigap and Prescription Drug Plans can be helpful in dealing with out-of-pocket costs that government-run Medicare won’t cover.
If Original Medicare does not provide the cover that you require, look into Medicare Advantage Plans that offer extra benefits like dental, vision, and prescription coverage.
Here's how to find a Medicare Advantage plan that meets your needs.
Decide on the type of Medicare Advantage plan you want: There are different types of Medicare Advantage plans that you can buy, such as HMOs, PPOs, MSAs, and SNPs. You'll also need to choose whether you want Part D coverage included in your plan (MA-PD) or if you just want coverage for Part A and B costs (MA-only plan).
Look at each plan's Medicare Star Ratings: Every Medicare Advantage Plan receives a star rating based on performance and the services they provide. The Centers for Medicare and Medicaid Services (CMS) releases updated star ratings each year to help consumers learn about the standards of service and products they’re getting.
Remember that Medicare Advantage Plans are location specific, and that not every plan may be available in your area. You may have different options based on where you currently live, and your plan may change when you move.
Some final tips to help you quickly find a Medicare Advantage plan:
- Read reviews online and do your research: If you want to find the best plan for your particular needs, you’ll need to dig a bit deeper.
- Find out what others think: See what consumers are saying about their experiences with companies, look at their financial history, and read up on what makes their products and services great.
- Work with an insurance agent to save time and money: There are many resources out there that can help you find a good Medicare plan. However, using the services of a Medicare insurance agent can help you navigate through Medicare quickly.
What Are the Best Companies?
Millions of Americans are using Medicare Advantage Plans to get broader coverage and access benefits that Original Medicare doesn’t offer.
We’ve looked at various Medicare Advantage options out there to come up with the best picks for Medicare Advantage Plans.
How do I know if I qualify for Medicare?
Medicare is open to people who are age 65 or older, younger people with disabilities and to those with End Stage Renal Disease. Learn more about Medicare eligibility.
When is the enrollment period for Medicare?
There are a few times when you can enroll in Medicare programs. The General Enrollment Period for Medicare Part A & B is between January 1 and March 31 of each year. Open Enrollment Period runs from October 15 and December 7 of each year and during this time:
- You can switch from Medicare Parts A & B to a Part C plan
- You can switch from Medicare Part C back to Parts A & B
- If you have or are signing up for Medicare Part A & B you can join, drop or switch a Part D prescription drug plan
- If you have Medicare Part C you can switch to a new Part C plan.
What is a Medigap/Medicare Supplement plan and how do they work?
It is an insurance policy that is sold by private insurance companies and is meant to fill in any gaps in Original Medicare coverage. It does so by helping to pay for some medical expenses that Original Medicare does not cover.
How is Medicare funded?
There are 2 trust funds held by the U.S. Treasury that are solely used for Medicare. Generally speaking, these accounts are funded by payroll taxes, income taxes on Social Security benefits, interest earned on trust fund investments, Medicare Part A premiums, Medicare Part B premiums and Medicare Part D premiums.
Are there different types of Medicare Advantage plans?
Yes - there are 6 types of Medicare Advantage health plans. These include: Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Services Plans (PFFSs), Special Needs Plans (SNPs), Medicare Medical Savings Account Plans (MSAs), Point of Service Plans (POSs). Learn more about Medicare Advantage Plans.
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