Medicare
Medicare is our country’s health insurance program for people aged 65 or older. And majority of Americans look forward to receiving these medical benefits. However, while the program helps with medical expenses, you have options to customize your Medicare plan.
What are the 4 parts of Medicare?
The four parts of Medicare offer you options to customize your Medicare plan. Below are the Parts and premiums involved.
Part A
Hospitalization Insurance
No Premium
Part B
Medical Insurance
Monthly Premium
Part C
Medical Advantage Plan
Monthly Premium (3rd party)
Part D
Prescription Drug Coverage
Monthly Premium (3rd party)
Who qualifies for Medicare ?
The program helps with the cost of health care, but it does not cover all medical
expenses or the cost of most long-term care. You have choices for how you get Medicare coverage.
- American citizens and legal residents over 65
- Those who have received Social Security or disability benefits for at least 24 months
- People with ALS or permanent kidney failure
How does my other insurance work with medicare ?
If you have another health insurance provider such as a group health plan or Medicaid while on Medicare, coordination of benefits determines who pays first. Each insurance provider is a payer; one will be the primary payer and the second coverage will be the supplemental payer. The primary will be pay first, and the supplement will be billed the outstanding balance. Below is an overview of some situations where this happens.
Retiree insurance
Medicare pays first
Age 65, group health coverage w/20+ employees
Your group health plan pays first
Age 65, group health coverage w/less than 20 employees?
Medicare pays first
Under 65, group health coverage w/100+ employees
Group plan pays first
Under 65, group health coverage w/less than 100 employees
Medicare pays first
Group health coverage with Early-Stage Renal Disease
Group health plan pays first for first 30 months
Medicaid
Medicare pays first
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FAQ
Questions everyone should ask about medicare
The best time to enroll is when you are first eligible at age 65. Known as your Initial Enrollment Period (IEP), this is a 7-month span covering your birth month and the three months before and after that month.
During the Annual Enrollment Period (AEP) you may change your provider or plan to a better one. You may switch from Original Medicare to a Medicare Advantage plan, add or drop Part D.
Medicare does not cover long-term care facilities, dental care, eye exams, cosmetic surgery, international care, hearing aids, or holistic medicine.
Medicare Advantage plans may cover these services though but may be limited. Original Medicare does not offer prescription drug coverage. That is a standalone plan under Part D.
It thoroughly depends on your Medicare package and needs. Part A is premium-free. In 2022, Part B premiums are $170.10 before late penalties. With Part A and Part B you will also have deductibles. Your monthly amount may also vary if you have a Medigap plan and/or Part D. This applies, too, for Part C.
If you receive Social Security your Part B premiums will be deducted from your monthly payment. If you are not receiving SS benefits, you have two options. You may pay quarterly with a mail-in check or sign up for Medicare Easy Pay for monthly electronic payments.
It is important to account for the future when considering Part D for prescription drug coverage. While you might not be taking prescription drugs now you may need them later. Part D helps with lower out-of-pocket costs and copays.
Medicare Supplement plans work by covering out-out-pocket costs after Medicare pays their portion. Your medical providers will bill Medicare first and then your Supplement plan is billed for the remaining balance. It is also called Medigap because it fills the ‘gaps’ Original Medicare does not
Original Medicare and Medicare Advantage are the two routes. It fully depends on how much coverage you would like and what you need. Original Medicare is only Part A and B with the option to enroll in Part D for prescription coverage. Medicare Advantage, known as Part C, offers additional coverage through private insurance companies for vision, hearing, and dental that Original Medicare does not offer.
If you are enrolled in any part of Medicare, you may not contribute to a Health Savings Account
In some cases, you may delay your enrollment in Part B and Part D if you are still working and have health insurance. However, it is recommended that you enroll in Part A since it is premium-free and will make enrollment for the other Parts easier down the road. Unfortunately, you may not qualify for penalty-free delay and will be paying higher premiums when you do enroll
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Additional Resources
For even more information, visit Medicare.gov or connect with Medicare experts.