New to Medicare?If you are new to Medicare, navigating thru the Medicare maze of information can be extremely tricky which means you probably have a lot of unanswered questions. Art of Medicare can help you decide which option is right for you, placing you on a clear open road to peace of mind.
Below are FIVE steps to getting you started with Medicare
Remember… YOU are IMPORTANT, YOU MATTER. |
What is Medicare?
Traditional Medicare consists of two parts, Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance). Traditional Medicare is available for all US citizens who are:
- Turning age 65
- Disabled by the Social Security Administration for 24 months
- Patients of a Dialysis Center due to end-stage renal disease
Medicare Part A - Hospital Care
- Inpatient Hospital Care
- Skilled Nursing Facility Care
- Long Term Care Hospitals
- Most people don’t have to pay a premium for Part A. You’ve already paid into the system in the form of the Medicare tax deductions on your paycheck.
Medicare Part B - Doctor, Outpatient Services & Supplies
- Doctor Visits
- Lab Tests
- Diagnostic Screenings
- Outpatient Care
- Home Health Services
- Medical Equipment
- Ambulance Transportation
- And other outpatient medical services
Medicare Part B also covers some Preventive Services
- Includes a one-time “Welcome to Medicare” preventive visit
- Flu and hepatitis B shots
- Cardiovascular screenings, Cancer screenings, diabetes screenings, and more.
- For a full list of preventive services covered under Medicare Part B, refer to the Medicare handbook, "Medicare & You"
Together, Parts A and B are commonly referred to as “Original Medicare”.
Medicare Part C – Medicare Advantage
Medicare Advantage Plans are an alternative to Original Medicare. They are offered by private insurance companies that contract with Medicare to provide you the same health care coverage and services as Original Medicare plus most plans also offer prescription drug coverage. Think of Medicare Advantage plans as a kind of a one-stop shopping choice that combines Part A, Part B, and usually Part D into one plan. They also may cover additional benefits that Original Medicare does not cover.
If you are enrolled in a Medicare Advantage Plan (MAPD) your services are not paid for by Medicare but paid by the private insurance company that you enrolled under.
If you are enrolled in a Medicare Advantage Plan (MAPD) your services are not paid for by Medicare but paid by the private insurance company that you enrolled under.
Types of Medicare Advantage Plans:
The area where you live might have all, some, or none of these types available. In addition, there might be multiple plans available in your area within the same type, if private companies choose to offer them. To see Medicare Advantage Plans available to you, visit Medicare.gov/plan-compare
- Health Maintenance Organization Plans (HMO)
- Preferred Provider Organization Plans (PPO)
- Private Fee-for-Service Plans (PFFS)
- Special Needs Plans (SNPs)
The area where you live might have all, some, or none of these types available. In addition, there might be multiple plans available in your area within the same type, if private companies choose to offer them. To see Medicare Advantage Plans available to you, visit Medicare.gov/plan-compare
Medicare Part D – Prescription Drugs
Medicare Part D is a federal program administered through private insurance companies. This is the part of Medicare that pays for some of your prescription drugs. You buy a Part D plan through a private insurer. Beneficiaries can enroll in a standalone Part D drug plan that goes alongside their Original Medicare benefits, or they can choose a Part D drug plan that is built-in to a Part C Medicare Advantage plan.
Frequently Asked Questions (FAQs)
Medicare is for people age 65 and older and younger people with certain disabilities. To determine your eligibility for Parts A and B, use Medicare's free online calculator.
Most people will sign up for Part A when they are first eligible at age 65. Part B is a little different because you will pay a monthly premium for it. If you have group coverage under your own or a spouse’s employment, it will probably be in your best interest to wait until you are retired or no longer eligible for that coverage.
The initial enrollment period spans three months before to three months after your 65th birthday. You can sign up for Medicare Part A any time during or after your initial enrollment period. If you sign up for Medicare Part B after this period, and you do not have group medical coverage through your or your spouse’s employer, you will face a late enrollment penalty. If you are covered under a group plan, you will be able to enroll in Medicare up to 8 months after your group coverage ends.
You can sign up for Medicare online or in person at your local Social Security office.
If you or a working spouse have paid Medicare taxes for at least 10 years, you will be eligible for a premium-free Part A. If not, your premium will depend on how long you have paid Medicare taxes. Most people receive Part A premium-free.
The standard monthly premium for Medicare Part B is $144.60 per month for 2020, but prices vary every year. It could be more if your income is over a certain amount, or if you do not sign up for Part B when you are first eligible.
If you have group health coverage through a current employer or spouse’s employment, and the employer has 20 or more employees, then generally the plan pays first, and Medicare pays second. If your employer has fewer than 20 employees, Medicare generally pays first.
No. Medicare covers most services deemed “medically necessary”, so it does not cover everything. Through coinsurance, co-payments, and deductibles, both Parts A and B have out-of-pocket costs which can add up. For example, you will be responsible for 20% of the cost of most Part B eligible expenses, but this amount could be more if you see a doctor who does not accept the amount Medicare agrees to pay for the service.
Medicare Supplement Insurance/Medigap is designed to work alongside Medicare by helping cover expenses. These plans are sold by private health insurance companies. If you are on the original Medicare Plan, you may want to purchase a Medicare Supplement Insurance policy, which is also called Medigap Insurance.
By law, companies can only offer standard Medigap insurance plans. There is a total of 11 standard insurance plans labeled A-N. Each plan offers a different set of benefits, fills different “gaps” in Medicare coverage, and they also vary in cost.
You will want to study all the Medigap plans before you decide which is best for you. No matter which insurance company you decide to purchase the plan from, all plans with the same letter cover the same benefits. For instance, all Plan “G” policies have the same benefits no matter which company sells the plan.