If you’re turning 65 soon, you might have some Medicare coverage questions. Or, you may have a loved one in their 60s and want to know more about Medicare coverage.
Here are some Medicare frequently asked questions and answers to help you make the right choice for you or a family member.
What if I already have coverage other than Medicare?
If you currently have insurance through your employer or spouse, you can keep this coverage and still enroll in Medicare. If you keep your employer’s coverage, you need to decide whether it’s primary (pays first) or secondary (pays the part not covered by the primary plan).
What’s the difference between Medicare Part A and Part B?
Part A pays for a hospital stay or if you need hospice care or a skilled nursing facility, as well as some care at home. You need to pay a deductible as well as coinsurance, and there’s no out-of-pocket maximum on what you pay for care. However, most people don’t have to pay a Part A premium since they or a spouse paid for Medicare with payroll taxes when they worked.
Part B pays for preventive services such as a flu shot or medically necessary care, including a doctor visit, outpatient care, and medical supplies such as a wheelchair. Other covered services include ambulance services and mental health treatment. You need to verify that care or equipment is covered by Medicare, or you may be responsible for paying the full cost. Most people pay a premium each month for Part B coverage.
Do I need Medicare Supplemental (Medigap) insurance?
This type of coverage helps to pay for expenses not covered by Medicare Part A and Part B, such as coinsurance, copayments, and deductibles.
If you plan to travel outside the U.S., you may want to consider getting a supplemental plan that provides coverage when you visit other countries. This is because Medicare plans usually only cover care that’s provided in the U.S.
What does Medicare Part C and Part D cover?
Medicare Part C, also known as a Medicare Advantage plan, is provided by a health insurer contracting with Medicare to provide Part A and Part B coverage. Unlike Part A and B, a Medicare Advantage plan has an out-of-pocket annual maximum and often covers prescription drugs as well as dental, hearing, and vision care.
Medicare Part D covers prescription drugs and is provided by an insurer approved by Medicare. Important tip: You may be required to pay a late penalty if you don’t get a Part D plan when you’re first eligible, and you sign up later for coverage.
When can I enroll in a Medicare plan?
Medicare has specific rules for when you can enroll for coverage:
- Initial Enrollment Period: This is the first time you can enroll and is for a seven-month period — the three months before turning 65, the month when you’re 65, and the following three months. If you don’t enroll during this period, you may have to pay a late enrollment penalty if you want Part B coverage at a later time.
- The Medigap enrollment period lasts for six months and starts when you’re 65 and enrolled in Part B.
- Important tip: If you don’t get Medigap coverage during this period, you may not be able to get coverage later or it might cost much more.
Have more questions regarding Medicare?
If you would like to ask other questions about Medicare coverage, visit The Long Term Living Association’s website at longtermliving.org or call 1-800-868-1193. Their experts can give you Medicare answers and help you decide what type of Medicare coverage is best for you or a loved one.