Medicare FAQ

Medicare FAQ

1. What is Medicare? Medicare is a federal health insurance program in the United States. It provides coverage for eligible individuals who are 65 years or older, certain younger individuals with disabilities, and individuals with end-stage renal disease (ESRD).
2. What are the different parts of Medicare? Medicare is divided into several parts:

• Medicare Part A: Hospital Insurance that covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health services.
• Medicare Part B: Medical Insurance that covers outpatient services, doctor visits, preventive care, medical supplies, and certain home health services.
• Medicare Part C: Medicare Advantage Plans offered by private insurance companies that combine Parts A and B benefits and may offer additional coverage like prescription drugs, dental, and vision.
• Medicare Part D: Prescription Drug Coverage that helps pay for prescription medications.

3. Who is eligible for Medicare? Eligibility for Medicare generally includes:

• Individuals aged 65 or older.
• Individuals under 65 with certain disabilities, such as receiving Social Security Disability Insurance (SSDI) benefits for a specific period.
• Individuals of any age with end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS).

4. When can I enroll in Medicare? You can enroll in Medicare during the Initial Enrollment Period (IEP), which typically starts three months before you turn 65 and ends three months after your birthday month. There are also Special Enrollment Periods (SEPs) for specific circumstances, such as if you delayed enrollment due to having employer group health coverage.
5. What is the cost of Medicare? The cost of Medicare varies depending on the parts you choose. Most people do not pay a premium for Medicare Part A if they or their spouse paid Medicare taxes while working. Medicare Part B and Part D have monthly premiums, which can vary based on income and other factors. Medicare Advantage Plans may have additional premiums.
6. Do I need additional coverage with Medicare? Original Medicare (Parts A and B) doesn’t cover all expenses. Many individuals choose to get additional coverage, such as Medicare Supplement Insurance (Medigap) policies, which help cover costs like deductibles and copayments. Medicare Advantage Plans (Part C) often provide additional benefits and may include prescription drug coverage.
7. Can I use Medicare anywhere in the United States? Yes, Medicare is accepted by most healthcare providers across the country. Original Medicare allows you to see any doctor or healthcare provider who accepts Medicare. Medicare Advantage Plans typically have a network of providers, so it’s important to check if your preferred providers are in-network.
8. What is the Medicare Part D “donut hole”? The Medicare Part D coverage gap, commonly referred to as the “donut hole,” is a temporary limit on what the drug plan will cover for prescription medications. Once you and your plan have reached a certain spending threshold, you may enter the coverage gap and pay a higher percentage of drug costs until catastrophic coverage kicks in.
9. Can I change my Medicare coverage? Yes, there are specific periods when you can make changes to your Medicare coverage. The Annual Enrollment Period (AEP) occurs each year from October 15 to December 7, during which you can switch Medicare Advantage Plans or switch from Original Medicare to a Medicare Advantage Plan. There are also other enrollment periods for specific circumstances, such as the Medicare Advantage Open Enrollment Period and Special Enrollment Periods.
10. Where can I get more information about Medicare? For more information about Medicare, you can visit the official Medicare website at www.medicare.gov or contact the Medicare helpline at 1-800-MEDICARe.