Healthy Seniors - We can help you navigate through all the Medicare options and changes for 2024.
Things to Know About Medicare
Four Plans
Part A covers hospital (inpatient, formally admitted only), skilled nursing (only after being formally admitted to a hospital for three days and not for custodial care), and hospice services.
Part B covers outpatient services including some providers' services while inpatient at a hospital, outpatient hospital charges, most provider office visits even if the office is "in a hospital", and most professionally administered prescription drugs.
Part C is an alternative called Managed Medicare or Medicare Advantage, which allows patients to choose health plans with at least the same service coverage as Parts A and B (and most often more), often the benefits of Part D, and always an annual out-of-pocket expense limit which A and B lack. A beneficiary must enroll in Parts A and B first before signing up for Part C.
Part D covers mostly self-administered prescription drugs.
Are you covered at work?
Employers offer their eligible employees the option to enroll in group healthcare plans that cover expenses related to medical services, prescription drugs, dental, and vision benefits. Group health insurance plans help employers save on administrative costs associated with individual policies and provide employees who don't have insurance from another source or employer access to quality health care coverage.
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If your group health plan is "creditable," you don't have to sign up for Medicare. Creditable is a term that only applies to Medicare, but in general, it applies to employers with more than 20 employees. Ask your employer if your plan is "creditable."
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However, it's always a good idea to make a comparison of Medicare’s benefits to your employee health plan.
Enrollment Times
If you're turning 65, you can enroll up to 3 months before your birthday, the month of, and another three months after. In most cases, your coverage for original Medicare will start on the 1st of your birthday month. However, if your birthday falls on the 1st of the month, your coverage will start a month earlier.
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Take advantage of the pre-65 enrollment time, so you don't miss any coverage gaps. In addition to turning 65, there is an Annual Election Period (AEP) during which anyone eligible can switch plans or modify their existing coverage from October 15th through December 7th. But if specific circumstances arise, such as moving out of your plan's service area, Special Election Periods (SEP) allow for enrollment outside these standard windows.
What It Costs
Original Medicare contains two parts: Part A and Part B. Patients must pay monthly premiums and other costs such as deductibles, copays, and coinsurance. The amount you have to pay may vary each year in January. For Part A, most people don't have to pay any premiums since they paid a tax during their working years. However, everyone must pay the premium for Part B to keep their coverage.
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You need to pay a deductible before Medical begins paying for your medical expenses. This amount can differ depending on the type of care you receive, for example, inpatient hospitalization or a doctor's office visit outside a hospital setting. In addition, there might be services not covered by Medicare at all, meaning you will have to bear the total cost yourself. Therefore, checking with your doctor before receiving a service is important to ensure your plan covers it!
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In addition to their premiums and co-payments, individuals with Original Medicare are also responsible for the total cost of any services that Medicare does not cover.