It is one of the most popular and useful healthcare insurance programs by US federal healthcare. Individuals who are 65 and older can apply for this healthcare program. In addition, younger adults that have certain disabilities can also opt for this healthcare program.
It is important to understand that there is a difference between Medicare and Medicaid, which is a government program. People whose income is below a certain limit opt for Medicaid. However, it is solely for retirees as well as individuals of 65. Medicare coverage includes four distinctive parts.
- Part A and B, with original Medicare for age 65
- Medicare C, also known as Medicare advantage
- Medicare Part D is a prescription drug plan.
Moreover, Medicare comes with supplemental plans to reduce the cost of the medical expenses you have to pay. Due to this reason, many citizens these days are opting for these benefits.
What is Original Medicare?
It comes in different parts. Therefore, it is vital to know about all of them so that you can figure out which plan works and various options before 65. Due to this reason, many people these days are opting for Medicare. The original Medicare covers both Part A and Part B, where the former is the hospital insurance and Part B covers medical insurance.
Part A mainly covers the typical hospital expenses that you need to pay post-surgery or illness. You will get automatically enrolled in semi-private hospital rooms, home healthcare, hospice care, home health care. All these conditions are applied to senior citizens of 65, for more convenience you can take the help of RRB.
Apart from that, Part A covers all the meals or other medical services you received when hospitalized. Coming to Part B, covers outpatient services for the age of 65. It helps in covering your visits to your doctor. Be it your primary care doctor or specialist checkups. Medicare is no doubt beneficial.
Moreover, the latter also covers some of the essential services as well like ambulance rides, lab testing, preventative care, diagnostic imaging, etc. In addition, services that take place in the hospital are also covered by Part B. For example, mammograms come under preventative care. Therefore, opting for a medi-claim will help in reducing your health costs as well.
Do you have to pay for Medicare Part A and B?
It is important to know how Medicare works for disability since it helps in understanding out-of-pocket costs. For example, most people think that there is no monthly premium that comes with Medicare special. However, as Part B is actually the medical insurance, it normally comes with a monthly premium.
The yearly-adjusted gross income determines the monthly premium. Even if you own original Medicare, you will be able to go to any doctor, which accepts Medicare patients.
How to sign up for Medicare?
There are various ways when it comes to signing up for the original Medicare. If you are getting social security benefits due to disability, you are automatically enrolled for both Parts A and B as soon as you reach 65.
Alternatively, if you fail to receive Social Security benefits at 65, it is best to sign up for original term using the security administration. But, it is important to understand that there are many specific periods to sign up for Medicare and special offers for disability. Therefore, you have to keep in mind that there are various periods to sign in to Medicare.
During your Initial Enrollment Period, you will have to register for the Medicare plan. However, even if you do not sign up for the original Medicare at the time of the Initial Enrollment Period, you can apply for it during the General Enrollment Period between 1 January and 31 March of every year. Otherwise, you can take the help of RRB.
When can you apply?
Once you turn 65, you can request Medicare; however, there are a few things that you need to know about it.
- At the time of the Initial Enrollment Period (IEP)
It is a seven-month period, which starts three months prior to your birthday month and includes the month when you will turn 65. Moreover, it continues for the upcoming three months. In case you are 65 and facing disability benefits, you can get automatically enrolled for distinct plans with the help of RRB. The plan starts three months before the twenty-fifth month when you receive the disability benefits. As a result, you become eligible for Medicare for the 25th month.
- At the time of the Special Enrollment Period
In many cases, you get the benefit of applying outside the normal registration period. For example, suppose that if you are getting coverage through an employer’s group plan as soon as you are 65 or above 65 you might delay Part B enrollment. Ideally, the Special Enrollment Period normally starts from the month where employment ends.
Where to apply for at 65?
If you want to apply for Medicare at 65, then you have to apply for it through the Security Administration. Then, all you have to do is visit ssa.gov, or you can take help from Social Security. Alternatively, if you want, you can take the help of RRB or Railway Retirement Board.
Are there extra coverage options for which senior citizens (of 65) can sign up?
You might have already understood that it comes in four parts. In the information mentioned above, you have read about Part A and B. Here is some other essential information on Parts C and D which might help you to take disability benefits
Medicare Part C is basically an advantage program. It is one of the best ways to get your Medicare Part A and Part B from a private Medicare-approved insurance company. Therefore, you can understand that it is quite important, and you will get all the benefits of it as well.
With the Medicare Advantage Plan, you can get prescription medicine coverage such as routine vision, dental care, etc. Coming to Part D, it is the prescription drug extension. However, it is important to keep in mind that it is optional coverage available through private approved health insurance companies. Hence, you won’t be automatically enrolled in any of these plans.
When you consider different options at 65, there are other kinds of optional coverage that you need to know. In case you stick with the Original Medicare, Part A, and Part B, you will know about the Medicare Supplement plan. Copayments, coinsurance, and deductibles are few Medicare expenses, which supplement plans may help cover. But the scope varies among different Medicare Supplement plans at an out-of-pocket cost.
Few Essential Unknown Things to Know About Medicare
There are many unknown things that you need to know about Medicare before you turn 65 and you can take the help of RRB.
- You can fill the Coverage Gap using Medigap Plan
It is important to understand that the traditional Medicare would ask you to sign up for the Medigap supplemental insurance plan. This helps in covering the deductibles, co-payments as well as other gaps, especially for disability. Moreover, if you want, you can switch the Medigap plans anytime you want to; however, you will be charged more than six months post signing up for Part B.
Most Medigap policies are normally identified through letters A and N. Every policy going by the same letter should offer the same basic benefits. Plan F is one of the most popular policies due to its comprehensive coverage.
- Opt for a Medicare Advantage for all-in-one plans
If you want, you can signup for the traditional Medicare, where parts A, B, D, and a supplemental Medigap policy. Alternatively, you can opt for signing up for the Medicare advantage that provides prescription drug coverage once you turn 65. The Part C Medicare advantage comes with a monthly cost along with the premium option.
Using the Medicare advantage, you don’t have to worry about the sign up for part D. Just like the traditional Medicare; you will be automatically enrolled to co-payments, deductibles as well as other out-of-pocket costs at 65.
- People with high income have to pay more for Medicare
If your income is above a certain threshold before 65, you might have to pay more for Parts B and D. However, the income thresholds for this year have not been announced. Surcharges the based on the adjusted gross income from two years earlier. During this year, the high earners pay about $207.90 to $504.90 per month for Part B based on their income levels in 2019.
- Medicare provides free preventive service.
Medicare beneficiaries receive many medical services from 65. You even get an annual free ‘wellness’ visit to develop and update personalized prevention plans and you can take the help of RRB. Moreover, the beneficiaries even get a free cardiovascular screening every five years, annual flu shots, and screenings for cervical, etc.
- Medicare provides telehealth offerings.
Even though the Medicare advantage plans have automatically enrolled telehealth for years, the traditional Medicare restricts service to few devices as well as practitioners even if you are 65. Even when the COVID-19 pandemic hit, telehealth was expanded. This helps patients use their smartphones in their houses to consult a broader range of medical professionals right from the comfort of their homes.
Things Medicare do not cover
Even though Medicare covers health care, it normally does not cover long-term care. Under normal conditions, especially after getting admitted to the hospital to treat any serious health condition, it will cover medical necessities for 65 years of age like skilled nursing facilities or even home health care. However, there are certain things that Medicare does not cover the costs of. For example, custodial care, which helps in dealing with daily activities like dressing as well as bathing. For covering the costs, you have to take the help of your savings or long-term care insurance. Moreover, traditional Medicare does not cover any dental or eye checkups.
Hence, medical coverage is a complex process and comes with hidden terms and conditions. Due to this reason, it is vital to check all the information carefully before you turn 65. Therefore, these are some of the most important things that you need to know about Medicare.