Medicare covers services (like lab tests, surgeries, and doctor visits) and supplies (like wheelchairs and walkers) considered medically necessary to treat a disease or condition.
If you're in a Medicare Advantage Plan or other Medicare plan, you may have different rules, but your plan must give you at least the same coverage as Original Medicare. Some services may only be covered in certain settings or for patients with certain conditions.
Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Certain conditions must be met to get these benefits.
Most people don't have to pay a monthly payment, called a premium, for Part A. This is because they or a spouse paid Medicare taxes while working. If a beneficiary doesn't get premium-free Part A, they may be able to buy it if they (or their spouse) aren't entitled to Social Security, because they didn't work or didn't pay enough Medicare taxes while working, are age 65 or older, or are disabled but no longer get free Part A because they returned to work.
Medicare Part B (Medical Insurance) helps cover doctors' services and outpatient care. It also covers some other medical services that Part A doesn't cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.
You pay a premium each month for Part B. If you get Social Security, Railroad Retirement Board, or Office of Personnel Management benefits, your Part B premium will be automatically deducted from your benefit payment. If you don't get these benefit payments, you’ll get a bill.
Most people will pay the standard premium amount of $121.80. However, if your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, you may pay an Income Related Monthly Adjustment Amount (IRMAA). IRMAA is an extra charge added to your premium.
Medicare Advantage Plans must cover all of the services that Original Medicare covers except hospice care. Original Medicare covers hospice care even if you're in a Medicare Advantage Plan. In all types of Medicare Advantage Plans, you're always covered for emergency and urgently needed care.
The plan can choose not to cover the costs of services that aren't medically necessary under Medicare. If you're not sure whether a service is covered, check with your provider before you get the service.
Medicare Advantage Plans may offer extra coverage, like vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D). In addition to your Part B premium, you usually pay a monthly premium for the Medicare Advantage Plan.
Most people will pay a monthly premium for this coverage. Everyone with Medicare can get this coverage that may help lower prescription drug costs and help protect against higher costs in the future. Medicare Prescription Drug Coverage is insurance. Private companies provide the coverage. Beneficiaries choose the drug plan and pay a monthly premium. Like other insurance, if a beneficiary decides not to enroll in a drug plan when they are first eligible, they may pay a penalty if they choose to join later.
A Medigap policy is health insurance sold by private insurance companies to fill the "gaps" in Original Medicare Plan coverage. Medigap policies help pay some of the health care costs that the Original Medicare Plan doesn't cover. If you are in the Original Medicare Plan and have a Medigap policy, then Medicare and your Medigap policy will each pay its share of covered health care costs.
Generally, when you buy a Medigap policy, you must have Medicare Part A and Part B. You will have to pay the monthly Medicare Part B premium. In addition, you will have to pay a premium to the Medigap insurance company. As long as you pay your premium, your Medigap policy is guaranteed renewable. This means it is automatically renewed each year. Your coverage will continue year after year as long as you pay your premium.
Q. What is the Initial Enrollment Period?
The Initial Enrollment Period (IEP) happens once, typically when you become Medicare eligible at age 64 and 9 months.
Q. When can I enroll in Medicare?
You are eligible for Medicare on your 65th birthday, but your Initial Enrollment Period (IEP) begins sooner. You can enroll in Medicare anytime three months before your birthday month and three months after it, providing a seven month IEP window.
Q. Do I have to enroll in Medicare when I turn 65?
You don't have to enroll in Medicare if you already have a health care plan but once you're Medicare eligible, it's a good idea to compare your current health insurance policy against a Medicare health plan. Sometimes the costs are lower and coverage the same or better than your employer's coverage. It doesn't matter if you are still working or haven't yet received your Social Security income check.
Q. Who is eligible for Medicare?
Medicare is a health insurance program for people age 65 or older. People under age 65 with certain disabilities may also qualify and people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant) qualify for Medicare.
Q. How do I find the right plan for me?
Rifaqat Khan can explain every part of Medicare and show you all of the Medicare and prescription drug plans in your area and make recommendations as to what will be best for you. Rifaqat Khan offers these services at no cost, and most licensed insurance agents are available for an in-home appointment.
Q. When will my Medicare plan go into effect?
Once you complete your enrollment paperwork, generally your proposed effective date will be on the first of the following month. If you enroll during the open enrollment period, your plan will be effective on January 1 of the next year.
Q. What is Medicare Advantage?
Medicare Advantage is commonly known as Part C. It is a type of Medicare insurance that combines Part A and Part B into a plan that not only covers the out-of-pocket expenses, but may provide additional coverage such as vision, dental, wellness programs, chiropractors and many more.
Q. Are prescription drugs covered in Original Medicare?
With a few exceptions, most prescriptions aren't covered in Original Medicare. However, the government has contracted with private insurance companies that can offer you this coverage at an additional cost. If you are entitled to Medicare Part A and/or enrolled in Part B, you can purchase Part D as a standalone program to cover prescription drugs.
Q. I have a pre-existing condition. Is there still a Medicare health plan option for me?
Yes. Within the plans that we offer, pre-existing conditions are covered. We may even have a solution for people with end-stage renal disease.
Q. How much does Medicare cost?
The price of Medicare depends on you the health plan that you choose. Medicare is not free and you will pay a premium, which is often deducted from your Social Security check, for Part B along with an annual deductible and a percentage, usually 20%, of the total bill. Purchasing supplemental insurance can help contain costs associated with deductibles, co-payments and prescription drugs. When meeting with a licensed insurance agent, make sure you understand any coverage rules that may affect your costs by asking them the following questions.
Q. Will my medications be covered?
Rifaqat Khan can help you choose a plan that offers the right medication coverage for you.
Q. What is the Open Enrollment Period and when does it start?
The Open Enrollment Period (OEP) happens every fall. During OEP you have the opportunity to change your health coverage and your health coverage provider without penalty. If a person is satisfied with their plan, they don't need to do anything.
Q. Is the Open Enrollment Period the only time that I can change my health plan options?
In most cases, the fall Open Enrollment Period (OEP) is the only time you can pick a new Medicare Advantage or Medicare Part D plan, so be sure to review your options.