Since 1966, residents 65 or older have been able to sign up for Medicare, the federal government’s health plan for seniors. But there are now private plans available, as well as a drug plan, giving people more options — but also raising more questions for beneficiaries.
Michelle P. Holzer, program manager for the Maryland Department of Aging’s State Health Insurance Assistance Program, offers answers to some of the most common questions people have about the program.
QUESTION: When do you apply for Medicare, and if you work, do you still apply?
ANSWER: If you are retired, you have a seven-month initial enrollment period to sign up for Medicare Part A and/or Part B, which begins three months before the month you turn 65, includes the month you turn 65, and ends three months after the month you turn 65.
If you are still working and are covered by an employer group health plan, then you may be able to delay the start of monthly Medicare Part B benefits (medical), but it is generally recommended you consider enrolling in Medicare Part A (hospital). Check with your employer’s health benefits office and Social Security for the rules regarding the Special Enrollment Period to sign up for Medicare Part B. If you miss the Initial Enrollment Period and are not entitled to a Special Enrollment Period, then you may face penalties and delays in getting your Medicare coverage.
If you are under age 65 and on Social Security because of a disability (SSDI), your Medicare coverage will begin after you receive 24 months of cash payments.
Q: How do you get the most out of Medicare, such as accessing preventive and wellness care?
A: Medicare covers many preventive and wellness services, such as annual wellness exams, mammograms, and flu shots, for example, without co-payments. Check your Medicare & You 2014 Handbook for a complete list of preventive and wellness benefits available to all Medicare beneficiaries.
Q: What is the difference between Medicare and Medicare Advantage?
A: Medicare is the federal government’s health insurance coverage for people 65 or older, people under 65 with disabilities and people of any age with end-stage renal disease (permanent kidney failure requiring dialysis or a kidney transplant). Medicare coverage consists of Part A (hospital) and Part B (medical) services. Most individuals pay monthly Medicare Part B premiums.
Medicare Advantage Plans (Part C) are a way to get your Medicare coverage through a private plan. They are managed-care plans and often referred to as HMOs and PPOs. Medicare Advantage Plans are run by Medicare-approved private insurance companies. They include all benefits covered under Medicare A and B, and may cover prescription drugs and extra benefits. Individuals pay monthly Medicare Advantage Plan premiums.
Q: What is a Medigap plan, and how do you know if you need one?
A: Medigap plans (Medicare supplemental plans) are sold by private insurance companies and help pay some of the health care costs that Medicare does not cover. … Medigap plans do not offer prescription drug coverage. Individuals pay monthly Medigap premiums. It is very important to join a Medigap plan during your “open enrollment period” — that is, six months from the time your Medicare Part B begins. Different rules for open enrollment apply for Medicare beneficiaries under and over the age of 65 regarding which plans you may choose.
If you consider purchasing a Medicare Advantage Plan (Part C) or buying a Medigap plan, then note that the start date for Medigap coverage or a Medicare Advantage Plan should coincide with the start date for Medicare.
Q: Will Medicare cover all of my medications?
A: Medicare does not cover most outpatient prescription drugs. There is some limited specific coverage of medications under Medicare Part A and Medicare Part B. Medicare offers prescription drug coverage to everyone with Medicare. A Medicare Part D Prescription Drug Plan or Medicare Advantage Plans offer prescription drug coverage. Medicare Part D plans are run by Medicare-approved private insurance companies. Not all medications are covered by all the Part D or Medicare Advantage Plans. Visit the Medicare plan finder at the federal website Medicare.gov, and do a search to determine whether your medications are covered and to find out the plan cost.
Q: Do Medicare Part A and B and Medigap supplemental plans have separate premiums?
A: Many people receive Medicare Part A (hospital) coverage free of charge if they have worked the appropriate number of quarters under Social Security. Most people pay a monthly Medicare Part B (medical) premium ($104.90 monthly in 2014). Medigap, Medicare Advantage and Medicare Part D premiums are paid to the private insurance company sponsoring the plan.
There are several financial assistance programs available for people who meet specific eligibility criteria to help pay for Medicare Part A premiums, deductibles and co-payments; Medicare Part B premiums and deductibles; Medicare Part D premiums and prescription drug co-payments; and Medicare Advantage costs.
Q: How do you find the best doctors and specialists who take Medicare?
A: Ask your medical providers if they accept Medicare and if they accept Medicare-assigned payments. The Medicare website, Medicare.gov, lists doctors and specialists in your area and whether they accept Medicare assignment.
Q: Does Medicare cover nursing home care?
A: Medicare covers semiprivate rooms, meals, skilled nursing and rehabilitative services, and other medically necessary services and supplies after a three-day-minimum medically necessary inpatient hospital stay for a related illness or injury. There are co-payments and limits on the number of coverage days for nursing home care. To qualify for care in a skilled nursing facility, your doctor must certify that you need daily skilled care like intravenous injections or physical therapy. Medicare doesn’t cover long-term care or custodial care.
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