Taking care of your health is important, especially if you’re reaching senior age. Medical care in the United States is not cheap, and if you’re not enrolled in a good health insurance plan, you could struggle to pay your medical bills. in order to avoid being in a bad situation, programs like Medicare were created.
If you’re interested in learning more about Medicare and what happens if you don’t enroll on time, keep reading. This blog will explain everything you need to know about it in Connecticut.
Understanding Medicare
Our country has several different health insurance programs, but Medicare is by far the largest. It provides coverage for people 65 or older, people under 65 with specific disabilities, and people of any age with ALS (Lou Gehrig’s Disease).
Payroll taxes primarily fund the program, and the federal government administers it. There are four parts to Medicare: Part A, Part B, Part C, and Part D.
With so many different parts and options, it can be confusing to know where to start. However, by reading below, you’ll get a deeper understanding of what Medicare is.
Parts of Medicare
Medicare has 4 parts that can adjust to your needs and capacity. Below, you’ll learn what they cover in more detail; read on!
What Medicare Part A Covers
- inpatient hospital care: Medicare will cover you for all care needed after being admitted to a hospital by a physician. This covers up to 90 days in a general hospital during each benefit period and 60 lifetime reserve days.
You’re also covered for up to 190 lifetime days if admitted into a Medicare-certified psychiatric hospital.
- Skilled nursing facility care: Medicare will cover the cost of your room, board, and some services in a skilled nursing facility. This coverage includes medications, tube feedings, and wound care.
- Home health care: If you spend at least three consecutive days as a hospital inpatient within 14 days of receiving home care, Part A coverage will kick in. This will cover up to 100 days of daily care or an unlimited amount of intermittent care.
Medicare Part B Coverage
Medicare Part B, listed on your Medicare Card as Medical, is designed to cover Medically Necessary Services and Preventive Services. This includes care from doctors and other health care providers, screenings, shots or vaccines, yearly Wellness visits, and many other preventive services.
You will be required to pay a deductible at the start of each year as you receive services. After that, you will usually need to pay 20% of the cost for any service approved by Medicare, commonly called coinsurance.
- Durable medical equipment: Equipment that is durable, functional, and safe for home use falls under this coverage.
- Ambulance services: in the event of an emergency, transportation by ambulance is covered. If there are no safe alternatives and it is medically necessary, limited coverage for non-emergency transportation may also be available.
- Certain prescription drugs: Part B covers drugs such as immunosuppressants, selected anti-cancer drugs, some antiemetics, and select dialysis drugs. Also, you can get other typical medications given by a doctor in an office or hospital.
The Coverage Provided By Medicare Part C
Most people know Medicare Part C as Medicare Advantage, which is administrated by private insurance companies that follow federal guidelines set by Medicare. These plans offer another way to get coverage for Parts A and B from approved insurers.
Most Medicare Advantage Plans require you to use a specific network of healthcare providers. These plans also include your Part D Prescription Drug coverage. Services typically covered by Medicare Part C include all emergency, urgent care, and almost all medically necessary services that Original Medicare covers, except for clinical trials and hospice services
Medicare Part D Coverage
The prescription drug benefit offered by insurance companies to Medicare beneficiaries is known as Part D. You can enroll in a stand-alone plan or choose a Medicare Advantage plan that also includes prescription drug coverage.
The drugs covered by each Part D plan are called formulary. If the drug you need is not included in the formulary, you can request an exception, pay out of pocket, or file an appeal.
Medicare Enrolling Process
If you want to avoid a penalty and coverage gap, sign up for Medicare during your initial enrollment period, which starts three months before turning 65 and ends three months after your birthday month. If you’ve recently moved, lost employer coverage, or become eligible for Medicaid, you may qualify for a special enrollment period.
Penalties For Not Enrolling in Medicare
You will be penalized if you do not have any other type of coverage when your initial enrollment period begins. These are the penalties you could face for not enrolling in Medicare on time:
Medicare Part A
You won’t be penalized for late enrollment if you aren’t required to pay a Part A premium. The Part A penalty is an extra 10% on your monthly premium. You’ll have to pay twice the number of years you were eligible for Part A but did not enroll.
Medicare Part B
Although you may want to delay signing up for Medicare Part B (medical insurance), it’s essential to know that there is a 10% penalty added to your monthly premium if you don’t enroll on time. The standard amount is generally multiplied by the number of years (12-month periods) you could have had Part B but weren’t enrolled.
Medicare Part D
Medicare calculates your Part D late enrollment penalty by taking 1% of the current “national base beneficiary premium,” which it’s expected to be $32.74 in 2023. That amount would be around 33 cents. They then round to the nearest $.10 and get $.30. After that, multiply the number of months by how many you were eligible for coverage under Medicare Part D but didn’t have it.
Nesso Medicare Provides You with Reliable Professionals & Outstanding Solutions
Nesso Medicare is part of Nesso Group; therefore, we focus on providing a comprehensive and multidisciplinary approach. We pride ourselves on our customer service, reliable professionals, and resourceful solutions. Our team understands that every client is different, so we offer tailored services.
Avoid paying penalties, and let us guide you through the Medicare process. We offer you the easiest and quickest way to cover your Medicare needs. Stop waiting, and let us assist you!
