Our healthcare needs often increase as we age. For retired people on a fixed income, managing the growing costs of medical expenses can be a challenge. Fortunately, government programs like Medicare are available to help. While Medicare doesn’t cover every healthcare bill, it can be used to help seniors 65 and up pay for many of their medical services, tests and devices.
If you have lots of questions about Medicare – don’t worry – you are not alone! Especially if it’s your first time signing up. “What are my options?” “How much does it cost?” “When do I sign up?”
Keep reading to learn about how Medicare works, what it covers and more.
What is Medicare, anyway?
The short answer: Medicare is a government health insurance program designed to help people after they turn 65, retire and lose the coverage they had from their employer.
Unlike other insurance plans, Medicare is partly funded through taxes you paid during the years you were working. Another difference between Medicare and the health insurance you may already be familiar with is that Medicare members can see any doctor who accepts it. And according to the Centers for Medicare and Medicaid Services, that’s 98 percent of providers across the country in 2023. Like traditional health insurance plans, Medicare plans have monthly premiums, co-payments on care and deductibles.
Understanding what Medicare covers and the costs that go along with it is key to budgeting and understanding what additional coverage (if any) you might want or need.
What does Medicare cover?
A lot. Made up of four unique “parts,” each one helps pay for different kinds of health-related services and items you might need.
Medicare Part A (Hospital Insurance):
Medicare Part A helps cover inpatient care in hospitals and skilled nursing facilities. It can also help cover hospice and home health care.
Medicare Part B – (Medical Insurance):
Medicare Part B helps cover doctor’s services and tests, outpatient care, medical supplies and equipment, and some preventive services like vaccines and screenings.
Parts A and B together make up Original Medicare, covering much of the medical care you’ll need, but not all of it.
Medicare Part C – (Medicare Advantage Plans):
Medicare Part C combines all the coverage from Parts A and B, with extra benefits that aren’t covered by Original Medicare.* Medicare Advantage plans also often provide dental, vision and hearing coverage, and savings on over-the-counter items, rides to doctors’ appointments, gym memberships and more. Many Medicare Advantage plans now even include coverage for prescription drugs. These are called “MAPD” or “MA-PD” plans.
*You must be enrolled in both Medicare Parts A and B before joining a Part C Medicare Advantage plan.
Medicare Part D – (Medicare Drug Coverage):
Also known as a Prescription Drug Plan, or “PDP,” Part D helps cover seniors’ prescription drug costs. Like Medicare Part C, it’s only available through private insurance companies that contract with Medicare. You don’t get Part D automatically – you have to select it, either by itself or as part of a Medicare Advantage plan.
Tip: Enroll in Medicare drug coverage as soon as you’re eligible. Waiting too long could cost you a late enrollment penalty – that’s a fee added to your premiums for as long as you have Medicare drug coverage.
How much does Medicare cost?
There’s no one-size-fits-all answer to this one. Costs can depend on lots of factors, like the type of plan you choose, what company you get your coverage from and even where you live. Here are some common Medicare costs you’re likely to hear about.
Part A costs
Most people have already paid for much of their Part A coverage through Medicare taxes taken out during their working years, meaning they get Part A benefits without having to pay a monthly Part A premium. People who haven’t contributed enough toward Medicare taxes while working might have to pay a monthly Part A premium for their coverage. Whether you pay a premium or not, Part A coverage also has a deductible and co-pays.
Part B costs
Medicare Part B members pay a monthly premium based on what their income is. On top of monthly premiums, there’s an annual deductible that members must meet each year before Original Medicare starts to pay for coverage. There are co-pays for hospital visits, tests and equipment. Visit the official Medicare website and try out their Premium Calculator to receive an estimate of your Part B premium cost.
Parts C and D costs
Costs for Part C Medicare Advantage and Part D Prescription Drug coverage will be different based on which company you decide on for your plan. Both Parts C and D have costs like premiums, deductibles and co-pays.
How do I make sure I have all the coverage I’ll need?
Since Original Medicare (Parts A and B) doesn’t cover all the things you need to stay healthy as a senior, you’ll need to find a way to “supplement” the things that are missing. Here are the two most common ways to do it.
Option 1: Sign up for a Medicare Advantage Plan (Part C) that includes prescription drug coverage
AARP says Medicare Advantage plans are becoming more popular since they combine coverage into one single policy rather than requiring different plans for hospital visits, medical care and prescriptions. Part A coverage, Part B coverage and (almost always) prescription drug coverage are all included when you choose a Medicare Advantage (Part C) plan. Not only that, nearly every Medicare Advantage plan comes with extra benefits that aren’t available from Original Medicare. Lots of Medicare Advantage plans have a low or even $0 monthly plan premium, and co-pays as low as $0 for things like visits to your primary care doctor and some prescription drugs.
Option 2: Stay on Original Medicare, sign up for a Medicare Supplement Plan AND sign up for a Prescription Drug Plan (Part D)
You might hear Medicare Supplement plans referred to as “Medigap.” These are insurance policies you can buy from private insurance companies to help cover some of the costs Original Medicare insurance won’t. Here are a few details you should know before signing up for a Medicare Supplement/Medigap plan:
- You must be enrolled in Medicare Parts A and B to get a Medigap policy.
- Medigap services are standardized, but the cost may vary depending on who your provider is.
- Supplement plans are only available with Original Medicare and can’t be used with a Medicare Advantage plan.
What’s the difference between Medicare and Medicaid?
Medicare is federal health insurance for people 65 and older. Medicaid is a federal and state program that helps cover some healthcare costs for people who have a limited or low income. People who qualify for both Medicare and Medicaid are called “dual eligible” and can still choose between Original Medicare and Medicare Advantage plans for their coverage.
Additional assistance programs
If you have a hard time paying Medicare premiums and co-pays but don’t qualify for Medicaid, there are four assistance programs that may help.
- The Extra Help Program offers assistance with premiums, deductibles and co-pays on prescription drug costs.
- The Qualified Medicare Beneficiary (QMB) Program helps cover lots of medical expenses including premiums, deductibles, co-insurance and co-pays for both Parts A and B. People who qualify for QMB automatically qualify for the Extra Help Program to help cover Medicare Part D costs.
- The Specified Low-Income Medicare Beneficiary (SLMB) Program helps people pay their Part B premiums. People who qualify also automatically qualify for the Extra Help Program.
- The Qualifying Individual (QI) Program offers similar assistance to the SLMB program. Recipients are required to re-apply each year and applications are granted on a first-come, first-served basis. People who have received QI assistance in the past are given priority.
What should I look for in a plan?
- Look at the plan’s costs. What will you pay for premiums, deductibles, co-insurance and co-pays?
- Check the plan’s benefits. Does it include what you’re looking for, like prescription drug coverage? What about dental care or eyeglasses?
- Make sure the plan is convenient for you. Are the in-network doctors, specialists and hospitals nearby?
When can I sign up for a Medicare plan?
With Medicare enrollment, timing is everything – and the best timing probably depends on your situation. The three main times are Initial Enrollment, Open Enrollment and Annual Enrollment.
- The Initial Enrollment Period (IEP) is your first time signing up for Medicare Part A and/or Part B. For most people, it’s when you’re turning 65 or when you’ve been approved for Medicare because of a disability. If you’re turning 65, Medicare gives you seven months to sign up: the three months before your 65th birthday, the month that you turn 65, and the three months after you turn 65.
- Medicare Advantage Open Enrollment happens every year between January 1 and March 31. During this time, if you have Medicare Advantage coverage, you can switch to a different Medicare Advantage Plan with or without drug coverage, or go back to Original Medicare and, if needed, join a Medicare Prescription Drug Plan.
- The Annual Enrollment Period (AEP) happens every year between October 15 and December 7. This is when you can choose a new plan for the upcoming year if you’re not satisfied with your current plan. Switch from your current Medicare Advantage Plan to a different Medicare Advantage plan, or switch back to Original Medicare.
Have questions or ready to sign up?
Visit the official Medicare website or call 1.800.MEDICARE (1.800.633.4227) 24 hours a day, 7 days a week.
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