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What is Medicare and What Does it Cover?

For those approaching the age of 65, Medicare can be confusing, and you might also be wondering how it compares to your current health care coverage. This guide addresses your questions about Medicare and how you might deal with coverage gaps.

Understanding Medicare

Medicare is a government program that provides medical insurance for United States citizens or permanent legal residents ages 65 and older. It is also available to younger individuals with disabilities. It is not the same as Medicaid, which is a similar program for qualifying low-income people of all ages.

Enrollment

Before you consider Medicare, make sure you are enrolled in social security benefit collection. You can do so through the Social Security Administration website in the time period of three months before and after your 65th birthday.

Original Medicare

Once you begin receiving your social security benefits at age 65, you are automatically enrolled in Medicare parts A and B (often called original Medicare). Medicare part A covers hospital costs and Medicare part B covers doctor visits. Prescription coverage, which is Medicare part D, is the only part you need to enroll in yourself as it is an optional add-on.

Medicare Advantage

You might be wondering, what about part C? This is where your options broaden. If you’re not satisfied with the coverage that parts A, B, and D provide, Medicare part C allows you to choose your benefits through a Medicare Advantage plan. Most standalone part C coverage has built-in prescription coverage, but if not, you can still supplement your coverage from part C with additional coverage in part D. Most part C plans offer extra benefits, such as vision, hearing, and dental, among others. So it is worth your time to explore those options to ensure you feel comfortable with your coverage.

Here is a summary of what we just reviewed:

  • Medicare part A – Covers hospital costs. You are automatically enrolled.
  • Medicare part B – Covers doctors visits. You are automatically enrolled.
  • Medicare part C – Medicare Advantage plan, which you can shop for yourself. It often includes prescription coverage, but you can supplement part C with any other part.
  • Medicare part D – Prescription coverage. You must enroll in this yourself if you want it.

Cost

Look at the cost guidelines on the official Medicare website for up-to-date premium numbers. It’s wise to talk to a Medicare insurance agent if you want to find the best prices and plans possible for a Medicare Advantage plan or if you have general cost questions.

The cost of your Medicare plan depends on which parts you’re enrolled in and a few other personal factors. However, all the plans have options to charge based on a monthly premium, which is a fixed amount you pay each month for your coverage.

There are also options to enroll in parts A and B with a deductible and coinsurance, which means you pay out of pocket for a set amount. Once your deductible has been spent, you may have 100 percent of the costs covered, or, for example, around 80 percent of the costs covered by your plan, and the remaining 20 percent will be paid by you.

Coverage guidelines

Now that we’ve gone over your options, let’s talk about how to choose the right coverage for you. According to most Medicare resource sites, these are the questions you should consider before enrollment.

Health

  • How often do you go to the doctor?
  • What health issues do you have or are you predisposed to?
  • Do you take medication regularly? If so, are you comfortable paying those costs out of pocket?
  • Do you have a specialist you see regularly?

Budget

  • What can you pay each month in premiums?
  • Are you able to pay copays or coinsurance for services?
  • Would a high out of pocket cost completely throw off your budget?

Preferences

  • Do you have doctors, hospitals, and pharmacies you like to go to?
  • Will you need health care coverage while traveling?
  • Are there additional coverages to consider, such as an employer or retiree plan?

Turning 65 is an incredible milestone, so don’t let Medicare options weigh you down. Talk to an agent about your questions and concerns after reviewing this guide to ensure you have peace of mind with your coverage.

Content provider: ReminderMedia

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