How Do I Know What Medicare Coverage Is Right For Me?
There are several factors you should consider regarding Medicare, especially when you are new to Medicare insurance. What are your current health conditions? Think through your annual medical expenses including routine visits and prescriptions. Do you have any chronic conditions that are being managed? Do you have any scheduled surgeries in the future?
Also, do you currently have other health coverage besides Medicare? This could be through an employer or a spouse’s employer. You may have coverage through another federal program such as the Veterans Administration. As a Medicare recipient, these coverages will be supplemental but could determine what plans you should purchase.
We have created multiple articles detailing the different parts of Medicare to help you gain an understanding of the various levels of coverage available. Also, you should understand how Medigap policies can help you cover many of the gaps in basic Medicare.
How Much Does Medicare Cost?
Medicare Part A will not cost you anything if you paid into Medicare payroll taxes throughout your working career. You will probably pay the Part B premium. Under some circumstances, you may not pay Part B if you are covered under an employer plan or based on income levels. Beyond premium costs, you need to consider deductibles, co-pays, and co-insurance.
Part A Hospitalization costs:
- $1,632 deductible for each benefit period
- Days 1-60: $0 coinsurance for each benefit period
- Days 61-90: $408 coinsurance per day of each benefit period
- Days 91 and beyond: $816 per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime)
- Beyond lifetime reserve days: all costs Part B Medical Insurance Costs:
- The standard Part B premium amount is $148.50 per month
- Part B deductible is $240.
- After your deductible is met, you typically pay 20% of the Medicare-approved amount for most doctor services (including most doctor services while you’re a hospital inpatient), outpatient therapy, and Durable medical equipment (DME)
You will also need to buy a Medicare Part D plan to cover prescription drugs. These insurance plans are sold in the private market and can vary based on what is available in your area.
To cover the extra deductible and co-insurance costs, you can also purchase a Medicare Advantage Plan (Part C) or a Medicare Supplement (Medigap) policy.
What Do I Do About Medicare If I Work Past Age 65?
If you are still employed after age 65, you can delay enrollment in many of the Medicare parts. You need to be careful and make sure your employer plan is creditable coverage. If it is not, and you do not enroll, you could be stuck with lifetime penalties.
How Can I Get Dental and Vision Coverage with Medicare?
Medicare does not cover routine dental or vision care. Some Medicare Advantage plans (Medicare Part C) will cover dental and vision. Medicare supplement (Medigap) policies do not cover dental or vision but you can purchase separately.
Is Medicare Mandatory?
No part of Medicare is technically required. However, you should enroll in Medicare when eligible. If you enroll after the Initial Enrollment Period opens, you could face financial penalties that will remain with your monthly payments throughout your life. There are exceptions if you are covered under creditable coverage such as employer health coverage.
Where Can I get Help Paying for Medicare?
Most people will not need to pay for Medicare Part A because they paid into the Medicare system throughout their working career in the form of Medicare tax. Part B has a small monthly premium, but there are programs to help people with limited income and assets. Some of the available programs are Medicaid, Medicare Savings Program, and Extra Help for prescription drugs.
A Medicare Nationwide agent can review your situation and determine what you may qualify for.
How does Medicare Automatic Renewal Work?
Medicare coverage choices will renew automatically unless you change your benefits. The plan costs and benefits can change from year to year as new Medicare regulations and rules become effective. It’s a good idea to review your Medicare choices every year, especially during the Annual Enrollment period that opens each fall between Oct. 15 – Dec.7.
For Medicare Supplement coverage, you can review these policies at any time during the year, and change our plan if you find one that offers a better value for your situation.
What’s the Difference Between Medicare and Medicaid?
Both Medicare and Medicaid are government healthcare programs. Medicare is generally for those 65 and older. Medicaid is designed for all ages that qualify based on income.
Some people will be eligible for both, which is generally referred to as dual eligibility.
If I am Disabled, Can I get Medicare Before I am 65?
Yes, in general, you can get Medicare before you are 65 after you receive Social Security disability benefits for 24 months. There are exceptions, and to understand what you are eligible you should speak to a Medicare professional.
Should you Enroll in Part D (Prescription Drug Coverage)?
Yes, you should enroll in Part D prescription drug coverage unless you are covered through an employer plan by yourself or through your spouse. Part D often comes bundled with Medicare Advantage. If you are eligible and do not have creditable coverage, you need to enroll. If you do not, you will owe potential surcharges if you sign up late.
What is My Budget for Medicare?
In addition to assessing your current medical expenditures, you should check your financial situation as you begin exploring your insurance options for Medicare.
Don’t only consider the potential premiums. Think about your ability to pay for out-of-pocket costs. Without having a Medicare Supplement or a Medicare Advantage plan, out-of-pocket costs can be significant. You can eliminate or mitigate those costs by enrolling in those other plans.
Is My Doctor Part of the Medicare Network?
It is easy to find out if your doctor is part of the network. Most doctors will advertise whether they accept Medicare and Medicare Supplements. Just a quick phone call to your doctor is all that’s needed. It is rare to find a doctor that does not take Medicare.
Medicare Advantage (Part C) can be very different. Medicare Advantage plans are similar to network plans in the private health insurance world. They are much more restrictive to networks. In fact, some people may not be able to purchase an Advantage plan because there are no networks in their geography. Before you make a decision about and Advantage plan, you should check the individual networks.
Medicare is also portable and can be used throughout the U.S. Medicare Supplements function the same way, and depending on the supplement plan you can even have international coverage if you travel regularly.
Advantage health plans aren’t always portable based on geography. If you travel often in the US or outside the country and are looking at an Advantage plan, make sure it is available where you plan on travelling.
What are the Most Popular Plans in My Area?
Once you enroll in Medicare, you will want supplemental health coverage such as a Medicare Supplement or Medicare Advantage plan. These plan help with out-of-pocket expense and will broaden Medicare standard coverage.
Coverages and rates vary based on geography. When you discuss your options with a Medicare agent, always ask about the most popular plans in your area. This will help you identify the most competitive and valuable coverages where you live.
When does Medigap Coverage Begin?
When you buy a supplement policy, make sure to know when coverage begins. This even helps with traditional Medicare, especially if you have an employer plan. You might consider dropping employer coverage due to cost once you are part of Medicare, but you need to understand the timing so you don’t have any gaps in coverage.
Are there Similar Plans for Lower Premiums?
If you have an Advantage plan or Supplemental plan, you may be able to find a similar plan for a lower premium. Sometimes you can find a plan with more coverage and lower premiums. You will feel like you’ve struck gold when you can put some of your healthcare expenditures back in your pocket.
This is why we recommend reviewing your coverages regularly because plans and pricing changes so often. A good agent can help you shop for coverage based on your circumstances and often find you something with a greater value than you have today. There are no time constraints on when you can shop your supplement plans.
What are the Out-of-Pocket Costs?
So often it is easy to only look at your bottom line premiums and not analyze your potential out-of-pocket costs. By not looking at your total costs, premiums and out-of-pocket, you could be spending more money on health care each year than you should.
Know what out-of-pocket costs you have and how to eliminate them. Eliminating out-of-pocket costs may be a cheaper option even though your overall premiums might be more.
Your bottom line costs are what are the most important for you.
Ask your agent what out-of-pocket costs you are responsible for. Understanding your expenses for doctors’ visits, medicines, and medical services is important. Unexpected changes can be financially exhausting.
Signing up for a policy after your OEP may be more expensive. However, you should feel comfortable and secure with your plan choice. Don’t be afraid to ask your agent any questions you have before deciding.
Find Your Medicare Agent
Once you’ve got all your personal information and Medicare member number, give one of our experienced agents a call at the number above to go over available plans. If you prefer, fill one of our forms out online. Our agents are happy to help, with no cost to you.
Make note of all the questions you have and talk to a licensed Medicare agent today. We can help you make the best decision for your medical needs. You’re not alone when comparing plans, our team of agents will do all the hard work for you.
Am I automatically enrolled in Medicare when I turn 65?
You are likely not automatically enrolled in Medicare when you turn 65. Unless you receive Medicare due to Social Security enrollment, you need to enroll. There’s a special seven-month window that opens called the Initial Enrollment Period to apply. The window is 3 months prior to turning 65, the month you turn 65, and 3 months after you turn 65.
Here’s who you should contact for more information:
- Official U.S. government Medicare: Visit Medicare.gov, or call 1-800-MEDICARE (800-633-4227)
- Medicare & You (.pdf): This handbook can be accessed from Medicare.gov and is published annually by the Centers for Medicare and Medicaid Services.
- Social Security Administration: 800-772-1213 and www.ssa.gov
- State Health Insurance Assistance Program: The program’s website, shiptacenter.org, features state-specific information.
- Trusted Medicare Agent: talking to an experienced agent can help you sort through all the regulatory language and wide variety of options you have to control your healthcare costs.
At Medicare Nationwide, our agents have years of experience and can help you find multiple competitive plans so that your overall bills are lower with greater value. We have contracted with hundreds of companies nationwide, and can shop your personalized health coverage while answering any questions you have.
Prefer to chat by phone? Give us a call at 1-888-559-0103.