Learning Center > 10 Frequently Asked Questions (and Answers) about Medicare

10 Frequently Asked Questions (and Answers) about Medicare

If you have questions about Medicare like, "Can I keep my doctor with my plan?" Or, "Does Medicare cover my medical procedure or service?" you’re in good company. Understanding and signing up for Medicare can be confusing, whether it's Original Medicare or a Medicare Supplement plan.

But fear not: We have the answers you’re looking for. Let's dive into 10 frequently asked questions and answers about Medicare, so you can learn how Medicare plans work and determine what's right for you.

1. What is Medicare?

Medicare is a federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant). Medicare typically covers the costs of emergency, preventative, and long-term healthcare.

Medicare is funded by the federal government, but various related programs, like Medicare Supplements, have state oversight. The two main categories of Medicare coverage include Original Medicare (with optional Medicare Supplement and prescription drug insurance) and Medicare Advantage.

2. Who qualifies for Medicare?

There are three groups who qualify to receive Medicare:

  • People who are 65 and older.
  • People under 65 years old who are disabled and who have been receiving Social Security Disability benefits for at least 24 months.
  • Qualified people with End Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis, also known as ALS or Lou Gehrig’s disease.

3. What does Medicare cover?

A wide variety of healthcare services are covered by Medicare, depending on the type of policy you choose, including:

  • Ambulance services
  • Anesthesia
  • Artificial eyes & limbs
  • Bariatric surgery
  • Blood processing & handling
  • Cardiac rehabilitation programs
  • Cardiovascular disease screenings
  • Cervical & vaginal cancer screenings
  • Chemotherapy
  • Depression screenings
  • Diabetes prevention programs
  • Diagnostic tests (laboratory and non-lab)
  • Eye exams (routine)
  • Eyeglasses & contact lenses
  • Flu shots
  • Foot care
  • Hearing aids
  • Hepatitis B and HIV screenings
  • Inpatient hospital care
  • Kidney transplants
  • Lung cancer screenings
  • Mammograms
  • Mental health care (inpatient and outpatient)
  • Occupational therapy
  • Opioid use disorder treatment services
  • Organ transplants
  • Pain management
  • Prescription drugs (outpatient)
  • Preventive & screening services
  • Radiation therapy
  • Sexually transmitted infections screenings & counseling
  • Sleep studies
  • Surgery
  • Urgently needed care
  • X-rays
  • Yearly "wellness" visits

4. Am I automatically enrolled in Medicare when I turn 65?

Many people automatically get Original Medicare - also known as Part A and Part B - especially if they’re receiving Social Security retirement benefits when becoming eligible for Medicare coverage. Other people may need to sign up for Medicare.

If you're aging into Medicare, you have a seven-month Initial Enrollment Period (IEP) to apply for Medicare: three months before you turn 65, the month you turn 65, and three months after you turn 65. And you must sign up individually for the parts of the program - Parts A, B, C and/or D - that you want.

5. Do I need Medicare if I already have health insurance?

It depends. You may need Medicare even if you already have other health insurance coverage, or if your current plan doesn’t meet the minimum coverage requirements.

Most plans that employers offer meet these standards. So if you have insurance through your job, you probably don't need Medicare. However, by staying on an employer plan, you can delay enrolling in Part B without a penalty and avoid paying Part B premiums.

An important note: When you have Medicare plus additional insurance policies, each provider becomes a "payer." The policy that pays for your specific medical services first depends on the coordination of benefits rules for your plans.

In other words, the primary payer will pay what it owes on your medical bills first, then the provider will send the remaining amount to the secondary payer to pay the rest.

6. What's the difference between Original Medicare, Medicare Advantage, and Medicare Supplement plans?

Medicare is divided into two categories, with Medicare Part D as an additional option for prescription coverage.

When signing up for Medicare, Part A is mandatory but Parts B, C, and D are optional. But keep in mind that you will incur a late penalty if you don't enroll in Parts B and D when you’re first eligible.

Here's a breakdown of the different Medicare parts and plans:

Part A (Original Medicare Plan)

Covers inpatient care in a hospital, inpatient care in a skilled nursing facility (not custodial or long-term care), hospice care, skilled nursing home care, and other types of home health care.

Part B (Original Medicare Plan)

Covers medically necessary services, preventative care, clinical research, mental health care, inpatient and outpatient services, partial hospitalization, and more.

Part C (Medicare Advantage Plan)

Combines Parts A and B into bundled coverage through an approved private insurance company that uses the Medicare network.

Part D (Prescription Drug Coverage)

Pays for several tiers of name brand and generic medications, sometimes up to a limit.

Medicare Supplement Insurance

Extra coverage through an approved private insurance company that fills gaps or "supplements" what Original Medicare doesn't cover. Also known as a Medigap plan.

You can typically buy Medigap insurance online to help you cover the out-of-pocket costs and additional services that are not covered by your primary plan As examples, a Medicare supplement plan may be used to cover copays, coinsurance fees, and deductibles.

A Medicare supplement plan is a standalone policy, so you’ll pay an additional cost for the plan outside of your primary Medicare premium. You must also have Medicare Part A and Part B to qualify for Medigap insurance.

Lastly, Medigap policies are guaranteed renewable, which means your insurance company can't cancel your policy if your health conditions change. You just have to pay your premiums on time.

7. Does Medicare cover dental and vision services?

Not usually. Original Medicare (Parts A and B) plans don't cover most dental services or vision care. But if you're already in the hospital, some dental or vision services may be covered.

Certain Medicare Advantage Plans (Part C) may cover dental and vision services, so make sure to check your policy before you enroll.

8. Can I have both Medicare and Medicaid at the same time?

In many cases, yes. Medicaid is a federally-supported program that helps states provide medical coverage for individuals with a limited income. So you may qualify for both if you meet the economic requirements for Medicaid and the age or disability requirements for Medicare.

Some states also provide expanded Medicaid access to individuals (including those with Medicare) who meet economic qualifications after subtracting their out-of-pocket medical expenses from their income.

For example: If you're a single person who earns $26,000 a year, you probably won’t qualify for Medicaid under normal program requirements. But if you live in a state with expanded access, you can subtract your medical expenses from your salary to come to a new income. So if you spend $7,000 on medical expenses, then your final income for your Medicaid application would be $19,000, so you might qualify for coverage.

Note: If you qualify for both programs, Medicare is automatically designated as your primary insurance provider while Medicaid becomes the secondary payer.

9. Which medications does Medicare Part D cover?

Medicare Part D coverage varies based on your insurance company, but all plans must include a minimum amount of medication coverage that's approved by Medicare.

So qualifying Part D plans must offer at least two medication options from each class of drug category on their formulary to treat common health issues. But not all health conditions are covered.

Check your insurance company's formulary (a list of generic and brand name prescription drugs covered by your specific health plan) to see what prescription drugs are covered. And fortunately, there are lots of other ways to reduce your prescription costs.

If you don't have a Part D plan, it can be added to any Original Medicare policy, Medicare Savings Account (MSA) Plan, some Medicare Cost Plans, and some Medicare Advantage Private Fee-for-Service (PFFS) Plans.

10. How do I check the status of my Medicare application?

The short answer is, "It depends."

If you applied for a standard Medicare Part A or Part B plan, you can check the status of your application by logging into your account on the Medicare website. Your application should show up in your profile within 24 hours of submission.

Still have questions?

Though we covered some common Medicare questions, you might still need help breaking through the jargon and choosing the best Medicare plan for your needs and budget.

You can get help with Medicare by talking to one of our licensed agents today. Or you can find and compare Medicare plans to see plan options in your area.

Get a Free Quote

Get a Free Quote

What you should read next

The transition from 2020 to 2021 offers many opportunities for people on Medicare. Whether you use Original Medicare, Medicare Advantage, or Medicare Supplement Insurance, you’ll find plenty of changes on the horizon. In this guide to 2021 changes to Medicare, we’ll review what happened during 2020, and dive into the Medicare changes and opportunities for 2021. Review of 2020 Medicare Changes To say that a lot happened in 2020 is a cosmic understatement. The big disruptor, of course, was COVID-19. The pandemic led to some sizable changes in the Medicare program. Some of the highlights from 2020 include: Medicare Supplement (Medigap) Plans C, F, and High Deductible F (HDF) were no longer available to newly-eligible beneficiaries as of 1/1/2020. For the second year in a row, the infamous “Donut Hole” was closed for Part D drug plans. Medicare expanded access to telehealth/virtual doctor appointment services. Many insurance companies, including the major Medicare Advantage plan sponsors, reduced or waived copayments for COVID-19-related care. Other than the COVID-19-related changes, the loss of Medigap Plans C, F, and HDF was probably the biggest change to Medicare for 2020. Those plans became unavailable for beneficiaries who first became eligible after 12/31/2019. This leaves Plan G as the most comprehensive Medigap plan available to all new Medicare beneficiaries. This plan will cover 100% of your Medicare deductibles, copayments, and coinsurance except for the Part B deductible. You’re responsible for the first $198 in Part B expenses for 2020. 2021 Changes To Medicare Some cost-sharing amounts for 2021 are not yet known - and it could be due to the uncertainty that COVID-19 created. As of now, it’s expected that 2021 Medicare Part B premiums, and Part A and B deductible amounts will be announced in November 2020. What we do know is that any 2021 Part B Premium increase will be capped by Congress. As part of a budget deal, Congress and the President limited any increase in Part B premium to no more than 25% of the calculated amount. This is designed to help prevent a dramatic increase in premium cost due to the effects of COVID-19. In general, you can expect relatively small increases in premiums. For historical context, here are the increases from 2019 to 2020: Part A deductible increased from $1,364 to $1,408 ($44 increase) Part B deductible increased from $185 to $198 ($13 increase) Part B base premium increased from $135.50 to $144.60 per month ($9.10) Keep in mind: The 2021 Part B premium increase will once again be capped by the Social Security cost of living adjustment for qualified Medicare beneficiaries on Social Security. This provision protects your Social Security check from shrinking due to Medicare premium increases. So, for 2021, you’ll have a double-protection against Part B premium increases. Medicare Advantage Plan Changes For 2021 Many of the most exciting and notable 2021 changes to Medicare encompass Medicare Advantage plans. These plans, which are also known as Part C plans, are a private insurance alternative to Original Medicare. Medicare Advantage And ESRD The single biggest piece of news about Medicare Advantage for 2021 relates to those with End Stage Renal Disease (ESRD), also known as kidney failure. Beginning 1/1/21, Medicare beneficiaries with ESRD will be able to get coverage through Medicare Advantage plans. Prior to 2021, Medicare Advantage plans were generally able to exclude people with ESRD. This left ESRD patients in a tough spot, since under Original Medicare Part B, they paid 20% of the cost of dialysis. And this can get expensive very quickly since there was no out-of-pocket cap on their expenses under Original Medicare. Everyone with ESRD will now be able to get Medicare Advantage coverage. This may not reduce the amounts ESRD patients pay early in the year, since many Medicare Advantage plans charge a 20% coinsurance for dialysis as well. However, the great news for ESRD patients is that every Medicare Advantage plan has an annual out-of-pocket maximum. So once ESRD patients hit their annual spending caps, they’re not required to pay for any more medical expenses the rest of the year. Medicare Advantage And Hospice Benefits Another 2021 change to Medicare Advantage is a small test program for delivering hospice benefits. Historically, hospice coverage was provided by Original Medicare, even if you were in a Medicare Advantage plan. Starting in 2021, 53 Medicare Advantage plans across the country will provide hospice and palliative care. This is a very small number of plans, so it won’t affect most people at this point. However, if the test program works, you may see more Medicare Advantage plans offering this benefit in the future. Extra Benefits Through Medicare Advantage Plans Medicare Advantage is the subject of other big 2021 changes to Medicare. Beginning in 2021, additional benefits will be available. Extra benefits are benefits offered by Medicare Advantage plans that are not covered by Original Medicare. Examples may include: Dental coverage Vision and hearing coverage Chiropractic care For 2021, new Medicare benefits will be available. Many of them are designed to help you get care at home, and lend some support to caregivers. The new extra Medicare benefits in 2021 available through some Medicare Advantage plans include: Caregiver support Adult day health services In-home support services Therapeutic massage Acupuncture (for chronic low back pain only – this is also now covered under Original Medicare) But these extra benefits are not required or guaranteed. Instead, they are optionally provided by Medicare Advantage plans, and they can be changed or discontinued from year to year. Still, the availability of adult day health services and caregiver support will be beneficial for many of those on Medicare who struggle to care for themselves. For 2021, Medicare Advantage plan premiums are lower on average than in the past. In fact, the average Medicare Advantage plan premium is expected to be 11% lower in 2021 than in 2020. For 2021, the average Medicare Advantage plan premium will be $21 per month. On the other hand, the annual out-of-pocket maximum for in-network services is rising to $7,550. This is the highest it can be. Many plans will continue to offer lower out-of-pocket maximums. 2021 Changes To Medicare Drug Plans The other big news in 2021 changes to Medicare is the Part D Senior Savings Model. This model program, which is essentially a five-year test, will cap the price beneficiaries in participating to no more than $35 copays for a 30-day supply for many types of insulin. Under this new program for 2021, beneficiaries will have access to about 1,700 MAPDs (Medicare Advantage plans with Part D drug benefits) and stand alone Prescription Drug Plans that cap the cost of insulin. Another great detail about this program is that the cost for insulin won’t change, even if you enter the coverage gap during the year. You’ll still pay the same capped copayment. In addition, you won’t have to meet a deductible to get the $35 copay price. While not every plan has chosen to participate, CMS expects there to be at least one plan in all 50 states, the District of Columbia, and Puerto Rico. Given the effect of diabetes on the kidneys, patients with ESRD are in position to grab some great new benefits for 2021 and beyond. How To Prepare For 2021 Changes To Medicare For starters, you should make note that we expect a slight increase in Original Medicare costs, for 2021. Though we still don’t know what they’ll be, we expect there to be some increase in the Part B premium, even with the caps that will limit the total rise in costs. You can expect the same thing with deductibles. As with a normal Medicare Open Enrollment Period, also called the Medicare Annual Election Period (AEP), you should review your current coverage to see if switching plans for 2021 makes sense. New plans are available each year, so Medicare beneficiaries have until December 7, 2020 to make a change to their plans for the 2021 plan year. When comparing plans during the Medicare Open Enrollment Period, be sure to look at: The monthly premium (if any) Annual deductibles (if any) Cost structure, like copays and coinsurance amounts for Medicare Advantage and Prescription Drug Plans Out-of-pocket maximum amounts for Medicare Advantage plans Networks of doctors and medical facilities for Medicare Advantage plans Tip: It’s important to not just jump into a new plan because it has one appealing feature. You want to make sure that your doctors accept any new plan and that your current medications will be covered. If you use insulin, you may want to consider one of the standalone Prescription Drug Plans or MAPD plans participating in the Senior Savings Model program, if available. It’s estimated that those on insulin could save more than $400 per year on average. Besides savings on insulin through the Senior Savings Model program, ESRD patients who don’t currently have Medicare Advantage plan coverage should consider it for 2021. Moving to Medicare Advantage could help ESRD patients in 2 different ways: Moving from Original Medicare to Medicare Advantage Moving from Medicare Supplement Insurance to Medicare Advantage In the first case, you can take advantage of the out-of-pocket spending cap that a Medicare Advantage plan can offer. The out-of-pocket cap could be a real benefit for ESRD patients since it’s not only dialysis treatments that could count against the Medicare out-of-pocket maximum (OOPM). All spending on Medicare-approved services and procedures count towards the OOPM, so an ESRD patient might “max out” their spending during 2021 and get substantial relief the rest of the year. On the other hand, if you have ESRD and are currently covered by a Medigap (Medicare Supplement) plan, you might be able to save money on your monthly premium by switching to Medicare Advantage. And you might save money or come close to breaking even by switching from Medigap to Medicare Advantage, depending on the premiums and out-of-pocket maximums for plans in your area. Just be sure you run the numbers before making this move. Note: It can be difficult to get Medicare Supplement insurance coverage back after you move away from it. You might have to go through medical underwriting, which means you may be declined coverage as an ESRD patient with a pre-existing condition, unless you qualify for a guaranteed issue period. Due to the complexities of Medigap coverage, it’s a great idea to talk to a licensed insurance agent to see if switching to Medicare Advantage is a good idea. Get Help With Medicare If you still have questions about 2021 changes to Medicare and how they impact you, a licensed insurance agent can help you out. Call (866) 955-0898 (TTY 711) to speak with a licensed insurance agent, or try our free Medicare plan comparison tool to find Medicare plans in your area. There is no obligation to enroll in a plan.
Read More »

The Medicare Annual Enrollment Period (AEP), sometimes called Medicare Open Enrollment or the Medicare Annual Election Period, starts on October 15. If you’re eligible for Medicare, you’ll probably receive lots of information over the next few weeks and throughout AEP. And this information can be overwhelming. But we’re here to help you with this useful Medicare guide. So let’s dive into the Medicare Annual Enrollment Period, what it is, how to prepare, and what you can do during AEP. Then, we’ll cover some tips for choosing the right Medicare plan for your healthcare needs. What is the Medicare Annual Enrollment Period? The Medicare Annual Enrollment period happens each year from October 15 to December 7. During this time period, you have the option to make changes to your Medicare coverage. Your new coverage would then take effect January 1. But if you’re satisfied with your current Medicare coverage, you don’t have to take any action during Medicare AEP. There are no penalties involved if you do nothing. Medicare plan details can change annually, though, so it’s wise to review your Medicare coverage each year. We’ll cover more on this shortly. What’s the Difference Between Medicare AEP and the Medicare General Enrollment Period? The Medicare Annual Enrollment Period is sometimes confused with the Medicare General Enrollment period, which is January 1 to March 31 each year. It’s important to understand the differences between the two enrollment periods. The Medicare General Enrollment Period is for Medicare beneficiaries who didn’t sign up for Medicare Part A or Part B when they first became eligible and aren’t eligible for a Medicare Part B special enrollment period. The AEP, however, is for beneficiaries who are already enrolled in Medicare and want to change their Medicare coverage. What Changes Can I Make During the Medicare Annual Enrollment Period? The first thing to know is that you cannot use the Medicare Annual Election Period to enroll in Medicare Part A or Part B for the first time. But if you’re enrolled in Medicare Part A and Part B and you’d like to change your Medicare coverage, here are some things you can do during the Medicare Annual Election Period: Change from Original Medicare to a Medicare Advantage plan. Change from one Medicare Advantage plan to another. Disenroll from your Medicare Advantage plan and go back to Original Medicare. Change from one prescription drug plan (Medicare Part D) to another. Enroll in a prescription drug plan. Cancel your prescription drug coverage. 5 Tips to Prepare for the Medicare Annual Enrollment Period There are many Medicare insurance carriers and plan options, but there are several steps you can take to be a savvy shopper and choose the right plan for your unique needs. 1. Mark Your Calendar This may seem like an obvious tip, but it’s worth mentioning: Mark your calendar for October 15 through December 7 if you’d like to make a change to your Medicare plan. You might even set aside a few hours to research and compare Medicare Advantage plans and Prescription Drug plans ahead of October 15. These plans announce their benefits for the next year starting on October 1. Writing down these Medicare AEP dates and to-dos will help you to commit to these priorities. 2. Review Your Medicare Annual Notice of Change You’ll receive lots of information over the next month or so, so if you’re currently enrolled in a Medicare Advantage or Prescription Drug Plan, the Annual Notice of Change (ANOC) is one piece of mail you’ll want to read. Your Medicare plan will mail your Annual Notice of Change letter to you by September 30. The ANOC letter will inform you of most changes to your Medicare health plan, including coverage and benefits that will take effect on January 1, 2021. Each year, your Medicare health plan sets the amounts it will charge you for premiums, deductibles and other services. Medicare doesn’t set these rates - but your insurance company does. With this in mind, the amounts you pay could change each year. While evaluating your current Medicare plan, you may want to ask yourself questions like: Did the plan cover the services I needed? Did I use out-of-network providers? Did I spend more out of pocket than I originally anticipated? Has something changed with my health (new diagnosis, new prescriptions, etc.)? The ANOC will also provide a side-by-side comparison of your current plan and next year’s plan benefits, costs and other changes (if any). Moral of the story: Don’t toss this piece of mail aside. Always review your ANOC to ensure your plan continues to meet your needs on an annual basis. And if you don’t receive your ANOC by September 30, contact your Medicare insurance company. 3. Make A List of What’s Important To Your Health Keeping a list of what’s important to your health is an invaluable way to prepare for the Medicare Annual Enrollment Period. Start by writing down all of your doctors, preferred health care facilities and hospitals, and prescription drugs, if you take any. We also recommend making a list of value-added benefits that may fit your health, lifestyle and budget. For example, you may be someone who likes to keep active and have social interaction. So a fitness program like SilverSneakers, which gives you access to a network of gyms and other programs, might be a good fit for you. A Medicare Advantage plan may provide these types of fitness or wellness programs. Another thing to consider is whether or not you have an elective surgery planned for 2021. If so, you’ll want to check your hospital-specific benefits under your current Medicare Advantage plan. 4. Check Your Plan’s Drug Formulary Your Medicare plan’s drug formulary will not be included in your Annual Notice of Change, so be sure you call your insurance customer service representative to see if your prescription drugs will be covered for the 2021 plan year. If your prescription drugs aren’t covered, it’s wise to use the Medicare Annual Enrollment Period to find a plan that does cover them. 5. Talk To Your Doctor Another “Medicare must-do” is to make sure all of your doctors and healthcare facilities will remain in network with your current Medicare plan. If they aren’t, you may want to take advantage of the Medicare Annual Enrollment Period. So be sure to ask your doctor if he or she plans on changing health plan affiliations over the next year. What Are The Benefits of A Medicare Advantage Plan? Understanding your Medicare plan options - starting with a Medicare Advantage plan - is a smart first step to take because you can switch, enroll into or disenroll from Medicare Advantage plans during AEP. Medicare Advantage plans, otherwise known as “Medicare Part C” or “MA Plans,” bundle Original Medicare (Parts A and B) services into one plan. While Original Medicare offers you a number of benefits, it may not cover health and medical services you might need. Medicare Advantage plans might be an attractive option because some plans include extra benefits that could save you money. These benefits may include: $0 monthly plan premiums Prescription drug coverage Dental, vision and hearing coverage Access to fitness programs Rides to medical appointments Help managing certain chronic conditions (congestive heart failure, COPD, diabetes) Medicare Advantage plans may also cover a number of in-home services to keep you safe and healthy at home, especially during these uncertain times due to the coronavirus pandemic. These benefits may include: Telemedicine services (also known as telehealth) Home-delivered meals Home-delivered prescriptions Private home aides Another potential perk of Medicare Advantage plans is that they include annual out-of-pocket maximums, which means your costs will be capped. But it’s important to note that Medicare Advantage plans vary by county and zip code. One way to compare Medicare Advantage plans and get Medicare quotes is through our easy-to-use quoting tool. Just enter your zip code to see Medicare Advantage plans that are available in your area. More Medicare Options for People With Kidney Failure One major change happening for the 2021 plan year is that people with End Stage Renal Disease (ESRD), also known as kidney failure, will now have the option to enroll in a Medicare Advantage plan. The Centers for Medicare & Medicaid Services (CMS) estimates that more than 80,000 people living with ESRD will enroll in a Medicare Advantage plan by 2026 - a significant increase of 63%. Medicare Advantage plans may provide ESRD patients with better coverage compared to Original Medicare. Many Medicare Advantage plans include access to coordinated care, which helps ensure all your doctors are on the same page regarding your treatment. What Are Medicare Advantage Special Needs Plans? Medicare beneficiaries also have access to Medicare Advantage plans designed for unique needs. These are called Special Needs Plans (SNPs). Like other types of Medicare Advantage plans, SNPs vary based on location. You may be able to switch to a Special Needs Plan during the Medicare Annual Enrollment Period if one of these situations apply: You’ve been diagnosed with a serious medical condition by a doctor. There are SNPs for certain chronic conditions, such as kidney and heart failure, diabetes and dementia. Services are tailored to the specific condition the plan covers. You need or have received skilled nursing care for at least 90 days at your home or at an institution, such as a nursing home or long-term care facility. You qualify for both Medicare and Medicaid. Medicaid eligibility is based on your income and assets. If you qualify, Medicaid will pay most of the costs for your Medicare Special Needs Plan. Special Needs Plans include all the same benefits as regular Medicare Advantage plans, plus some expanded coverage. For example, all Special Needs Plans must include prescription drug coverage, which is usually tailored to the specific condition the plan covers. Although most regular Medicare Advantage plans include prescription drugs, some do not. Some SNPs also provide a care coordinator to help you stay on track with your doctor appointments and treatment plan. What If My Income Has Changed in 2020? The coronavirus crisis has affected the financial well-being of many Americans, including those on Medicare. If you’ve experienced a decrease to your income or assets, the Medicare AEP 2020 season is a great time to switch to a more affordable plan. If you have limited income, you might qualify for extra savings on Medicare costs through these programs: Medicare Savings Programs. These programs help pay for some of your Medicare Part A and Part B out-of-pocket costs, such as copays, deductibles and premiums. Most programs are for Medicare beneficiaries who also qualify for Medicaid. And as mentioned, Medicaid covers the majority of your costs when you join a Medicare Advantage Special Needs Plan. You can check if you qualify through your local Medicaid office. Medicare Extra Help. Extra Help reduces your Medicare prescription drug plan costs. You should contact Social Security to check your eligibility for Extra Help if you have an existing Medicare drug plan or you join one during AEP. How To Enroll During the Medicare Annual Enrollment Period To enroll in an eligible plan during the Medicare Annual Enrollment Period, you can visit Medicare plan comparison websites like healthinsurance.com or Medicare.gov. Or, you might prefer to talk to a licensed insurance agent to get help enrolling in Medicare. Whatever option you choose, be sure to have 3 items handy before you enroll in a plan or make changes to your current plan during AEP: Your Medicare card Your list of doctors, prescriptions and what is important to your health Pen and paper to take notes More on Medicare Eligibility Medicare is a federal health insurance program developed in 1965. To be eligible for Medicare you must meet one of the following criteria: You are age 65 or older You are under age 65, disabled, and have been receiving Social Security disability benefits for at least 24 months. You have End Stage Renal Disease or Lou Gehrig’s Disease (also known as Amyotrophic Lateral Sclerosis or ALS). You can visit Medicare.gov to see if you’re eligible for Medicare and calculate your estimated premiums for certain plans. Medicare Resources You don’t have to go it alone when choosing a Medicare Advantage plan or Prescription Drug Plan. We’re here to help you navigate the Medicare Annual Enrollment Period through a number of ways, including our Medicare resources and our licensed insurance agents. You can also read through some of our articles to learn more about Medicare. Medicare 101 Guide Top Medicare Frequently Asked Questions Understanding Original Medicare vs. Medicare Advantage
Read More »

People often have questions about Medicare as they get close to age 65: Does Medicare cover my prescription drugs? Will my doctor accept my Medicare plan? Does my Medicare plan cover dental, vision, and hearing? These are questions we often hear, and we’re here to help get you these answers and more. Let’s start by reviewing the basics of Original Medicare, including coverage and out-of-pocket costs. Then we’ll cover some options to reduce your Medicare costs and add valuable benefits to your coverage. How Original Medicare coverage works Original Medicare is split into two parts – Part A and Part B. Medicare Part A Covers some of the costs of care provided by the following facilities and providers: Inpatient hospital care Hospice Care Home Health Care Skilled Nursing Facility Care Medicare Part B Covers medically necessary services and supplies, including: Doctor’s visits Diagnostic tests (x-rays, blood work, MRIs, etc.) Therapy visits (physical, occupational) Some cancer treatments like chemotherapy Outpatient surgeries like arthroscopic surgeries Outpatient mental health visits Durable medical equipment like bottled oxygen How much does Original Medicare cost? When you use your Medicare insurance, you will have to pay for some of the costs out of pocket. But the out-of-pocket costs are different for Parts A and B. When you have a hospital stay, you’ll have to pay the Part A deductible which is $1,408 in 2020. You’ll pay this inpatient hospital deductible each time you are admitted to the hospital, provided you haven’t received hospital or skilled nursing facility services within the previous 60-day benefit period. Meanwhile, Part B has three types of charges: Part B deductible: $198 for 2020, which you only pay once each year. After that, Medicare will pay 80% of the cost, and you’ll pay 20% for every Medicare-covered Part B service or procedure you receive. Part B coinsurance: 20% of the cost for each service or procedure Part B excess charges: Up to 15% of the Medicare-approved charge if your doctor does not accept the Medicare-approved amount for a service (known as Medicare assignment). For the most part, your out-of-pocket costs could be quite low if you’re healthy and don’t need many health care services. And if you get the flu or need some therapy for a sprained ankle, your 20% coinsurance could total a few hundred dollars for the entire year. But your out-of-pocket costs could be very high if you suffer a major illness or need specialized surgery. Plus, Original Medicare does not cover prescriptions. So if you need medications, costs could be high. One last point on costs: There’s no cap on your spending with Original Medicare. This means there’s no out-of-pocket maximum cap like you may have seen with your previous traditional, private health insurance plan. And this means your out-of-pocket costs could be extremely high if you require treatment for a chronic condition or illness. Medicare Advantage may help control costs Many Medicare beneficiaries choose to enroll in Medicare Advantage plans to curb out-of-pocket costs and get prescription drug coverage. Medicare Advantage (also known as Medicare Part C) is a contract between the Centers for Medicare and Medicaid Services (CMS) and a private health insurance company. Medicare Advantage plans must cover everything that Original Medicare covers. When you join a Medicare Advantage plan, you may still pay for certain expenses including: Monthly plan premium (if any): Many plans have a low-cost or $0 monthly premium. (You must continue to pay your monthly Part B premium). Annual deductible (if any) Copayments and/or coinsurance Still, these costs are often lower than what you’d pay under Part A or B. One big benefit of a Medicare Advantage plan is that it includes an annual out-of-pocket maximum - so you’ll know your costs are capped, no matter what services or treatments you might need during a year. Medicare Advantage provides extra benefits Medicare Advantage can serve as a way to cover services that Original Medicare doesn’t. That’s because these plans often go beyond Original Medicare coverage offerings. These extra benefits can vary by state and health plan, but they often include: Chiropractic care and acupuncture. Dental coverage: Sometimes for an additional premium. Emergency coverage outside of the United States Fitness benefits: Discounted or free gym memberships and silver sneakers programs. Hearing coverage: Exams, and sometimes discounted hearing aids. Prescription drug coverage: You’ll typically share the cost of your medications with your insurance company in the form of copayments or coinsurance for each prescription. Transportation: To and from medical appointments. Vision coverage: Exams, lenses, and the cost of frames. An example of how it works Let’s take vision coverage as an example. Original Medicare doesn’t cover basic vision services like eye exams and lenses. If you pay out of pocket, you can expect to pay (on average): $114 for an eye exam $113 for lenses $238 for frames Based on these averages, you could pay a total of $465 for an exam, lenses, and frames. While benefits vary by state and insurance company, many Medicare Advantage plans have exams and lenses for $0. Many companies could also give you a credit towards the purchase of frames. And though you probably don’t buy new glasses every year, it’s unlikely that prices for lenses and frames will decrease. Getting frames from a Medicare Advantage plan can save you quite a bit of cash, especially given the relatively low (or $0) plan premiums they charge. You will find that other extra benefits work in the same way. The hearing or dental coverage available from Medicare Advantage plans may not be completely comprehensive or free, but it’s often less expensive than what you can get from an individual policy. How Medicare Supplements can help control costs Medicare Supplement insurance is another way to lower your Medicare out-of-pocket costs. These policies are offered by private insurance companies and work with Original Medicare, paying for some or all of the costs that you’d normally pay. The costs you have to pay with Original Medicare are known as “gaps in coverage.” Medicare Supplements help to fill these gaps - hence the name “Medigap” plans. You’ll pay a premium directly to your insurance company for Medigap coverage. And Medigap can help with some or all of: Part A deductibles Part B deductibles Part B coinsurance Part B excess charges Medicare Supplement plans come in standardized plans, with each plan paying a slightly different portion of the Original Medicare gaps. The standardized plans are known by letter: A, B, C, D, F, G, K, L, M, and N. Plans F, G, and N are among the most popular with people on Medicare. Medigap plans offer a lot of freedom when it comes to choosing a doctor. Your coverage is portable all over the country, so you can see any doctor who accepts Medicare patients. You don’t have to deal with a network, or get a referral from a primary care physician. As an added bonus: Many Medigap plans also cover you outside the United States, so you can have emergency coverage while you’re traveling as part of your retirement routine. What Medigap plans don’t cover There are a number of items that Medicare Supplement insurance doesn’t cover. For starters, they don’t cover prescription drugs, so you’ll need to enroll in a stand alone prescription drug plan to help cover costs. These are also available from private insurance companies. Medigap plans also don’t cover vision, hearing, or dental. While it’s possible that some Medigap plans offer discounts on these items, none provide comprehensive coverage. Medigap plans also provide no coverage for staying in a nursing home or other facility for long-term care. Instead, you’ll have to purchase individual coverage from an insurance company to cover these items. Or, you may be able to purchase coverage for some of these items from your Medigap insurer in a separate supplemental policy. With either option, you’d pay an additional premium for the coverage, but buying standalone vision or dental coverage from another company might be the more expensive option. How to enroll in a Medicare Advantage or Medigap plan The most important thing to know is that you’re not “stuck” in a Medicare plan: If you want to switch Medicare plans, you can do so during the Annual Enrollment Period, which is from October 15 to December 7 each year. You can also switch from one Medicare Advantage plan to another, or go back to Original Medicare during the Medicare Advantage Open Enrollment Period, which is from January 1 to March 31 each year. And if you want to learn how to reduce your out-of-pocket medical expenses in the meantime, you just need to get smart on maximizing your Medicare benefits. Save time, learn more Let us do the hard work for you, so you can save time and find the best Medicare plan for your needs. Working together, we can find and compare Medicare Advantage plans in your area to see if they work with your doctors and cover your medications.
Read More »

Healthinsurance.com LLC is a commercial site designed for the solicitation of insurance from selected health insurance carriers. It is not an insurer, an insurance agency, or a medical provider. You may obtain a complete list of available Medicare plans by contacting 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

This site is not maintained by or affiliated with the federal government’s Health Insurance Marketplace website or any state government health insurance marketplace.