What is Medicare?
- People 65 and older;
- People with certain disabilities, regardless of age; and
- People of any age with permanent kidney failure requiring dialysis or a kidney transplant (End-Stage Renal Disease or “ESRD”).
If you are eligible now, or if you will be eligible in the near future, it’s time to learn how Medicare works. It all boils down to understanding the “parts” and how they work together to provide the health care coverage you need for your personal situation.
- Medicare Part A (Hospital Insurance) pays for the inpatient care you receive in a hospital when you are admitted for an inpatient stay. It also helps cover skilled nursing facility, hospice, and home health care.
- Medicare Part B (Medical Insurance) pays for the doctor visits and outpatient care you receive as a hospital patient if you are not admitted for an inpatient stay. It also helps cover some preventive services to help maintain your health and to keep certain illnesses from getting worse.
- Medicare Part C (Medicare Advantage) provides independent, Medicare-approved, private insurance that extends your health care coverage. Medicare Advantage Plans are a way to get the benefits and services covered under Part A and Part B through private insurance at a government subsidized rate.
- Medicare Part D (Medicare Prescription Drug Coverage) helps cover the cost of prescription drugs. It may also help lower your prescription drug costs and help protect against higher costs. Medicare Part D is run by Medicare-approved private insurance companies.
Medicare Part A and Part B together are called Original Medicare. Your big decision is whether to use Original Medicare or a Medicare Advantage Plan. The following chart will help you decide which way to get your coverage.
Your Medicare agent can help you choose the options that best suits your situation.
Original Medicare vs. Medicare Advantage
Original Medicare does not cover everything. It offers the basic coverage you need, but you will need to pay some of the costs. If you require more than the basic health care coverage, you can enroll in a Medicare Advantage plan, a Medicare Part D prescription drug plan and/or a Medigap supplement insurance plan. These plans provide additional benefits and help pay for the costs that are not covered by Original Medicare.
Here are some of the more common health care services that are not covered by Original Medicare:
- Most dental care
- Routine eye care
- Routine hearing tests
- Most care while traveling outside the United States
- Custodial care (help with bathing, dressing, eating, etc.)
- Long-term care
- Cosmetic surgery
- Most chiropractic services
- Routine foot care
Original Medicare does cover the following preventive services:
- “Welcome to Medicare” Preventive Visit (one-time)
- Yearly “Wellness” Visit
- Abdominal Aortic Aneurysm Screening
- Bone Mass Measurement
- Breast Cancer Screening (Mammogram)
- Cardiovascular Screenings
- Cervical and Vaginal Cancer Screening
- Colorectal Cancer Screenings, including Fecal Occult Blood Test, Flexible Sigmoidoscopy
Colonoscopy, and Barium Enema
- Diabetes Screenings
- Diabetes Self-Management Training
- Flu Shots
- Glaucoma Tests
- Hepatitis B Shots
- HIV Screening
- Medical Nutrition Therapy Services
- Pneumococcal Shot
- Prostate Cancer Screenings
- Tobacco Use Cessation Counseling (counseling for people with no sign of
How to Apply for Medicare
The Social Security Administration is responsible for administering the Medicare program. They handle most of the application forms and paperwork.
The first letter you get in the mail about Medicare will come from your Social Security office. If you’re already getting benefits from Social Security or the Railroad Retirement Board (RRB), chances are that you’ll be automatically enrolled in Original Medicare (Parts A and B).
Your local Social Security office can also help you find out if you’re eligible for financial assistance to help with the cost of a Medicare plan.
Your Existing Health Care Plan After Age 65
How you use your existing health care coverage when you are eligible for Medicare has a lot to do with coverage you have and how it’s provided. However, in any case, as you start looking at your Medicare options, you should keep your current health care plan in mind to make sure you get the coverage and options you need.
- If you’re retired, you may have retiree health care coverage from your former employer, the military, or your union.
- If you are still working, your employer may offer additional health care coverage that’s tailored to seniors.
- If the situations above do not apply to you, then you may need to purchase your own health insurance. A Medicare agent can help you find the plan that’s right for you.
To learn how Original Medicare works with the coverage you have now, and discover how you can save money or get more features by enrolling in another Medicare plan, call today. Our licensed agents have all of the information you need.
Depending on your financial status and you current or past employment situation, you may have more options available to you than the standard Medicare choices. It’s critical to review your health care needs and finances with a Medicare professional to be certain you receive the coverage you need at a rate you can afford.
Changing Your Medicare Plan
As your health and finances change, you are likely to find that your Medicare plan choices no longer meet your needs. Relax, that’s OK. You’re never locked into one plan permanently with Medicare. Each year you can change plans during the Medicare Annual Enrollment Period (AEP).