Medicare is Complicated

But Understanding Medicare is Essential to Your Well Being

Medicare is a complicated topic.  With over 60 million Americans relying on Medicare, it is important that seniors understand it to use it.  Read on to learn the basics of Medicare to help you or your loved one stay well!

Medicare Basics

Eligibility

Medicare is a federal healthcare program.  Only certain people qualify for Medicare.  Qualifications include 65 years or older or have a qualified disability.  To receive Medicare, a person must be a citizen for 5 years or longer.

4 parts of Medicare

  • Part A covers inpatient, nursing home up to 100 days, home health care, and hospice.  Premiums may apply, however, most people do not pay a premium.  Deductibles apply.
  • Part B covers physician, outpatient, preventative screenings and immunizations, surgical services and supplies, physical and speech therapy, medically-necessary ambulance service, diagnostic tests, wheelchairs and other durable medical equipment, prosthetic devices, and blood transfusions. Premiums and deductibles apply.
  • Part C, Medicare Advantage, is an alternative to Medicare Parts A and B.  Part C is similar to a Health Maintenance Organization (HMO) Plan.  Premiums and deductibles apply.
  • Part D covers prescription drugs.  Premiums and deductibles apply.

Medicare Image, seniors, planning, future

Medicare Myths and Facts

There are common myths about Medicare than many people believe.  Here are some myths and facts seniors need to know.

Myth:  Medicare covers 100% of healthcare costs

Fact:  Medicare part A coverage varies depending on the service.  Part B covers approximately 80% of healthcare costs.

Myth:  Medicare and Medicaid are the same

Fact:  Medicare and Medicaid are not the same.  There are large differences between Medicare and Medicaid.  The federal government oversees Medicare.  The state oversees Medicaid.  Eligibility for Medicare is age and qualified disabilities.  Income and assets determine Medicaid eligibility.

Myth:  Anyone can enroll in Medicare at anytime

Fact:  There are strict enrollment periods for Medicare.

Initial Enrollment Period for Parts A & B:  7 months surrounding 65th birthday-3 months before, birthday month, and 3 months after

General Enrollment Period:  Open to all eligible recipients.  January 1-March 31 with effective coverage on July 1.  Able to make changes during General Enrollment Period

Special Enrollment Period for Older Workers:  Available when no longer receiving work benefits through 8 months.

Open Enrollment for Medicare Part D, prescription drug coverage, is November 15 to December 31st only

Myth:  Medicare is Free

Fact:   Part A costs around $400 a month (2017).  Some people do not have to pay the premium.     

        Part B costs around $135 a month (2017)

        Part C, Medicare Advantage costs vary

        Part D, Prescription Drug plan costs vary.  Additional costs are income dependent

Myth:  Medicare Supplements are the same as Part C, Medicare Advantage

Fact:  Medicare Supplements provide additional insurance to traditional Medicare benefits.  Medicare Advantage, Part C, replaces Medicare Parts A and B.  Medicare Part C, Medicare Advantage is an HMO plan and costs less than Parts A and B for in-network-physicians.

Conclusion

Deadlines, multiple parts, varying premiums, deductibles, and coverage complicate Medicare.  However, understanding Medicare is important for seniors to use it.  Medicare.gov is a great place to learn more about benefits and costs.

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