Approximately 18.5% of American people are enrolled in Medicare. Still, it’s something not many people know enough about. With multiple misconceptions surrounding it, it may seem like a complex system to navigate for some.
In this blog post, we’ll break down Medicare for you and answer some of its most common questions. We’ll also discuss signing up for Medicare and the different options. So if you’re close to retirement or already past that, keep reading!
What Is Medicare?
Medicare is a federal health insurance program administered by the United States federal government that’s available to people 65 years of age or older and to some younger people with disabilities.
It’s funded by taxes and premiums paid by beneficiaries, providing coverage for the medical needs and care of those who acquire it.
How Does Medicare Work?
Medicare has four parts: Part A, Part B, Part C, and Part D. People eligible for Medicare can enroll in one or more. Most people enroll in Parts A and B, known as Original Medicare.
People who choose Original Medicare can also add on a prescription drug plan (Part D) or a supplemental insurance plan to help cover costs not covered by Medicare. Some people opt for a Medicare Advantage Plan (Part C), which provides all of the benefits of Original Medicare plus additional benefits like vision, dental, and hearing insurance.
No matter how you receive your Medicare plan, you’ll probably need to pay premiums (monthly payments) for most of the plans. You may also have to pay deductibles (a set amount you pay each year before your coverage starts) and coinsurance (a percentage you pay for covered services after you reach your deductible).
How Is It Beneficial?
Without Medicare, many people would be unable to afford the high cost of medical care. Medicare provides important benefits, such as:
- Ensuring people stay healthy and avoid serious diseases
- Helping seniors afford the medications they need
- Helping seniors and other Americans access the medical care they need
- Reducing overall healthcare costs
- Make it possible for seniors to live longer and healthier lives
Why Is It Important?
Medicare remains an essential part of the United States safety net. It has been an invaluable resource for seniors and disabled people and significantly impacted their lives. For many, it’s the difference between being able to afford necessary medical care and going without. Without Medicare, most would not have access to the necessary health care.
Medicare Eligibility and Coverage
Eligibility
People eligible for Medicare must be:
- 65 years of age or older
- A legal resident of the United States for at least five years
- A citizen or have permanent residency status
There are also some exceptions for people who are under 65 and have certain disabilities or conditions, such as:
- End-Stage Renal Disease (ESRD)
- Lou Gehrig’s disease
In the past, patients with ESRD couldn’t enroll in Medicare Advantage plans. However, as of 2021, the 21st Century Cures Act has changed this, giving people with this condition the option to sign up. This is great news for patients, as it’ll allow them to cover the treatment they need.
Coverage
There are four essential parts of Medicare.
- Part A
Part A is sometimes called “hospital insurance.” It covers inpatient hospital care, skilled nursing facility care, hospice care, and home health care. People with Part A typically pay no monthly premium for their coverage. They become eligible when they turn 65, have a disability, or suffer end-stage renal disease.
- Part B
Part B covers a wide range of medical services, from doctor’s visits to preventive care. It also covers some mental health services, durable medical equipment, and home health care.
While Part B has premiums, deductibles, and copays, it is still a vital program that can help seniors stay healthy and independent.
- Part C
Medicare Part C, also known as Medicare Advantage, is a health insurance plan that covers everything that Original Medicare and Part D cover. The plan may include extra benefits such as dental, vision, and prescription drugs.
Medicare Advantage plans are offered by private insurance companies that contract with Medicare. Each plan has its own list of services and benefits. To be eligible, you must be enrolled in Part A and Part B of Medicare. You must also live in the service area of the plan you’re considering enrolling in.
- Part D
The program provides seniors with access to affordable prescription drugs. Part D plans are available through private insurance companies, and each plan has its own list of covered drugs.
Seniors can choose a Part D plan that best meets their needs. The Centers for Medicare and Medicaid Services set the premium, and seniors are responsible for paying it in addition to their monthly Medicare Part B premium.
Does not cover:
- Long-term care
- Dental care
- Cosmetic surgery
- Vision care
- Hearing exams
Cost
Most people enrolled in Original Medicare pay a monthly premium for Part B coverage. The standard Part B premium is $170.10 per month in 2022. Some people enrolled in Part A (hospitalization) may also pay a monthly premium of $274.
The cost of prescription drug coverage under Part D will vary depending on the chosen plan. If you’ve exceeded $4,430 between you and your plan, you’ll have to pay no more than 25% of the costs of the necessary drugs. <when it comes to Plan C or Medicare Advantage, the average cost is $19 per month.
Medicare Open Enrollment in 2022
Every year, from October 15th to December 7th, Medicare beneficiaries have the opportunity to review their coverage and make changes for the upcoming year. This is an important time to ensure you’re still enrolled in a plan that meets your needs.
There are a few things to keep in mind as you consider your options for next year.
- Medicare plans can change from one year to the next, so it is important to be aware of any changes in coverage or costs.
- You may be eligible for a different plan if your circumstances have changed.
- It’s a good time to review your prescription drug coverage and make sure that you’re still getting the best possible price for your medications.
There’s an extended enrollment period for people who couldn’t complete their sign-up during the normal window due to a disaster or emergency. To enroll, people who qualify for the extended period will have up to eight weeks after declaring the disaster or emergency.
Changes You Can Make During The Process
If you’re pleased with your current plan, you don’t need to do anything during Open Enrollment. Your coverage will automatically renew for 2022. If you’re not happy or need to make changes, now is the time to do it.
During Open Enrollment, you can:
- Change from Original Medicare to a Medicare Advantage Plan.
- Switch from one Medicare Advantage Plan to another.
- Drop your Medicare Advantage Plan and return to Original Medicare.
- Join a stand-alone Prescription Drug Plan or switch to another plan.
The decisions you make during Open Enrollment will affect your coverage and costs for the entire year. Make sure you take the time to review your options and choose the one that’s right for you.
Changes You Can’t Make
You must be aware of some important exceptions during the enrollment period.
- Medigap plans are only guaranteed-issue in most states during a beneficiary’s initial and limited special enrollment period.
- If you didn’t enroll in a Medigap plan when you were first eligible, you might not be able to do so during the regular open enrollment period. You’ll need to wait for the Medicare general enrollment period, which runs from January 1st to March 31st.
Why and When Do You Have To Register?
Many people don’t know that there is a specific time during which they must sign up for Medicare coverage. This initial enrollment period (IEP) begins three months before the month of your 65th birthday. It begins with your birthday month and ends three months afterward.
It’s important to sign up for Medicare during this time frame because you’ll avoid any late-enrollment penalties. The penalties are not a one-time charge. Instead, it’s a recurring fee; the longer you go without Medicare, the higher it’ll be.
How To Choose The Correct Plan?
There are so many different parts to Medicare, each with its own set of benefits. Figuring out on your own where to begin and which plan is right for you can be overwhelming.
Still, a licensed agent will be able to explain all of the different options to you and help you choose the most adequate plan. They’ll listen to your needs and give unbiased advice on using your Medicare benefits. They can also guide you on how to sign up for a plan and answer any questions you have along the way.
Medicare Enrollment Process Has Never Been Easier
At Senior Nesso Benefits, we help seniors choose the Medicare plan that fits their needs and budget. Contact us today to learn about the enrollment process and ensure you don’t miss any important dates or relevant information.
Our purpose is to help you stay healthy and independent. We’ll do everything we can to ensure you have the coverage you need. Trust our knowledgeable team at Nesso Group and navigate a transparent and honest process.
