Healthcare is so complicated and everchanging that there are newsletters dedicated to its politics. Medicare is the federal government-issued healthcare plan that kicks in when you’re 65.
However, everyone’s Medicare is a little different, as are their medical needs. This means that you likely have some questions about your coverage, and what other options are available.
That’s why this article will answer some of the most common Medicare questions you may have. Knowing how to navigate the system, and what Medicare covers, can help you achieve the best health outcome possible at the lowest cost.
5 Medicare Questions You Need Answered
While this guide seeks to answer some of the most common concerns you may have, it is not exhaustive. Keep in mind that Medicare is not the same as Medicaid, which is the state equivalent.
What is Medicare?
As already mentioned, Medicare is health insurance offered by the federal government. It kicks in at 65, which is supposed to be retirement.
Medicare is split into parts A and B. Part A does not have premiums attached to it (so long as you’ve worked at least ten years), while Part B does. Part A offers coverage for hospital treatment, while Part B covers other medical expenses.
Specifically, this means that Part A covers hospital stays and emergency care, as well as some long-term care like nursing or hospice care, in some cases. Part B, on the other hand, covers more general medical care, like doctor’s visits, vaccines, physical therapy, and medical equipment like wheelchairs.
The premium that you have to pay for Part B depends on how much money you make in a year. In 2019, if you make less than $85,000 a year, you’ll have to pay $135.50 a month. A full chart is available on the CMS website.
On top of that, your deductible for Part B is $185 for 2019. This means that you’ll only have to cover the first $185 of a medical bill. These numbers increase each year, so it’s important to stay on top of any changes.
When Can I Enroll?
You can enroll in Medicare Part A at any time starting at three months before you turn 65. For Medicare Part B, there is a seven-month window from three months before you turn 65, your birthday month, and three months afterward. Failing to sign up for Part B during that time means that you will be hit with a late enrollment fee later on.
Keep in mind that if you are already taken Social Security benefits, you will enroll in both Parts A and B automatically on the first day of the month you turn 65.
Should I Sign Up for Part B?
If you are already retired, you should absolutely sign up for Part B during the enrollment window. However, keep in mind that since Part B comes with premiums, it will represent an additional cost on your fixed income.
If you’re still working and covered by an employer’s insurance plan, it may make sense to wait to enroll. While you will be hit with a late penalty, you will also save money on the premiums and still enjoy full coverage through your job.
What is Medicare Part C?
Medicare Part C, also sometimes called Medicare Advantage, is a type of health insurance plan that isn’t actually offered by the government. Private health insurance companies offer Part C to cover the cost of prescription drugs. This provides coverage that parts A and B don’t offer.
Another key difference is that Medicare Advantage plans is that they have a maximum out-of-pocket fee. Medicare Parts A and B do not, which means costs can get out of control fast.
With Medicare Advantage, the maximum you will pay per year is $6,700. After you hit that number, the plan will fully cover all covered expenses.
Medicare Advantage plans are either offered by HMOs or PPOs. HMOs, or Health Maintenance Organizations, offer lower out-of-pocket charges, but will only cover doctors and specialists within their network. Since they only cover a limited network, costs are lower.
PPOs also have networks of doctors and hospitals that you can see for a lower rate. However, they will still provide some coverage if you go out of network. Going out of network will still cost more, but you won’t be paying the full cost.
The caveat of choosing a PPO over an HMO is, of course, the higher monthly premiums you’ll have to pay.
What is Medicare Part D?
Medicare Part D plans are also offered by private health insurance companies. They only cover prescription costs. Each health insurance company will cover a different list of drugs and will charge a different amount for coverage.
In some cases, the same or similar drugs will be covered, but under different brand names. It’s important to make sure that the medicine that you need is covered by the Part D plan that you choose.
Medicare Plans Provide Good Coverage, but They’re Not the Only Option
While the range of plans makes Medicare seem complicated at first, knowing the above information can help cut through the sea of information. Medicare can help you access affordable treatment, and the different parts, when combined, form comprehensive coverage.
If you have more Medicare questions, feel free to check out the Medicare section of our website. From there, you’ll be able to determine if Medicare is the right health insurance for you, or if private individual and family plans are a better choice