Medicare is a federal program that ensures those aged 65 and over receive health insurance. However, understanding your Medicare options can feel overwhelming if you're not familiar with the basics. With so many factors and unknown aspects to keep in mind, it's important to research which options will work best for you.
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Breaking Down the Basics
To begin, let's break down the four parts of Medicare: parts A, B, C and D.
- Part A: Primarily covers hospital care, including hospice, at-home healthcare and nursing facility care.
- Part B: Primarily covers doctor and healthcare provider services. This includes medical equipment (wheelchairs, hospital beds and walkers), outpatient care and preventative services (such as vaccinations, screenings and tests).
- Part C: Part C is most commonly known as Medicare Advantage. It's split into two types of plans: Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO), involving a combination of parts A, B and D. Medicare Advantage plans typically have lower out-of-pocket costs and more service coverage (such as dental and vision).
- Part D: This helps cover the cost of prescription drugs and is run by private insurance companies that follow specific Medicare guidelines.
Frequently Asked Questions
Now that we've covered the A's, B's, C's and D's of Medicare, let's go over some common questions:
- How do I qualify for Medicare? To qualify for Medicare, you must be 65 or older. Medicare is also available to those with certain qualifying disabilities or people of any age who suffer from end-stage renal disease (ESRD).
- When should I sign up for Medicare? Whether or not you're covered by private insurance, it's still important to know your Medicare options. Don't wait until the last minute -- start reviewing your options a few months prior to your 65th birthday. Taking the time to research and choose a plan that works best for you is essential since you can only change your Medicare plan during the open enrollment period (October 15 to December 7).
- How do I enroll? If you receive social security benefits or are under 65 with a disability, you will automatically be enrolled in parts A and B. However, it's important to note that if you are not automatically enrolled (which is the norm), you will need to enroll online or over the phone. If you don't enroll in Medicare part B or D, you will pay a late percentage fee on your premium.
- How do I know if my current providers accept Medicare? Most doctors and providers accept Medicare, but it's crucial that you check with your providers prior to switching. If they don't accept Medicare, you might consider finding a new doctor.
- Where can I get reliable information about Medicare and my options? You'll find many resources and details at Medicare.gov, the official government website for Medicare. For a more personalized approach, El Camino Health offers many services that can help you navigate Medicare, from virtual consultations to free Medicare counseling at our Health Library & Resource Center.
Medicare Tips to Keep In Mind
As you begin researching your Medicare options, we've compiled some tips that can help you get started:
- Start looking at your Medicare options before you turn 65: You have a seven-month period in which you can enroll in Medicare without late-enrollment penalties (three months prior to your birthday, the month of your birthday and three months after your birthday).
- Consider working with a broker: Brokers can be a great resource. Not only is it free to work with them, but they can give you unbiased information and even help you enroll in Medicare.
- Before selecting your Medicare plan and doctor, think about your personal preferences: Consider location, language and appointment options as you try to decide which doctor is right for you.
Whether you're enrolling in Medicare for the very first time or looking to make changes to your current plan, El Camino Health can help. Start by finding a doctor or by downloading our Medicare tip sheet.
This article first appeared in the March 2021 edition of the HealthPerks newsletter.
