What Is Medicare and Will I receive it?
In the simplest terms, Medicare is federal health insurance for seniors 65 years and older or younger people with certain disabilities. Learning about Medicare options can feel overwhelming. Many aren’t sure where to begin. Medicare offers several parts, plan options, and coverage stages, it can be difficult to know which method of receiving your benefits is the best for you. However, once you understand the basics of Medicare, choosing your coverage options will be much easier.
Let the experienced staff at The In Group answer your Medicare questions as well as assist you when choosing a Medicare Advantage Plan or Medicare Supplement Plan.
Below, we will go into a little more depth into the different parts of Medicare.
Who is eligible for Medicare?
The initial eligibility age for Medicare is 65. Some people can get Medicare earlier if they are disabled or have specific conditions, like end-stage renal disease (ESRD) that requires dialysis or Lou Gehrig’s disease (amyotrophic lateral sclerosis).
What are Medicare's Limitations?
Medicare does not cover all medical costs. There may be costs associated with medical care that you will be responsible for.
Medicare is also not a welfare program. To qualify for free Medicare Part A, you must have worked and paid Medicare taxes for at least 10 years to be eligible for benefits. However, you can still be eligible for Medicare Part A with less than 10 years of work history if you meet all other criteria, but you might have to pay a Part A premium. There are some exceptions, but this is the general rule.
Medicare Basics: What Are the Four Parts of Medicare?
Original Medicare = Parts A & B (Medicare Pays Most & You Pay Rest)
If you are already collecting Social Security, you will be automatically enrolled in Original Medicare and receive your Medicare card in the mail a few months before turning 65. If not, you can go online to www.medicare.gov and follow the directions to formally enroll in Medicare Parts A & B up to 3 months prior to your 65th birthday.
- Part A: (Hospital Coverage Only) – No cost as long as you have paid into Medicare through your working years (or through a Spouse). You are eligible the first day of the month that you turn 65 years old.
-
Part B: (Physician/Medical Coverage) – Monthly premium is $164.90 for most people in 2023. This amount could be higher based on your income but also starts the first day of the month you turn 65. If you are still working and have credible heath care coverage through your employer, you can delay taking your Medicare Part B, until you retire or discontinue your employer healthcare plan. Once this happens, simply apply at www.medicare.gov.
It is important to remember that Original Medicare does not provide benefits for Prescription Drugs, Dental, Vision or Hearing! These can be acquired through a secondary insurance. -
Part C: (Insurance Company Pays Most & You Pay Part) - Medicare pays insurance company to take care of all your medical claims. Most plans cover hospital, medical and prescriptions. Plans can also include dental, vision, hearing, mental health, foot care, gym membership and other extras. Premiums are the same regardless of age.
When enrolled in an Advantage Plan, you can only switch to another Advantage Plan during one time a year. The Annual Enrollment Period occurs from October 15th – December 7th each year, with plan changes effective the following January 1st. Special circumstances also allow changes to occur.
You generally must get care and services only from “In-Network” doctors and hospitals, except in emergencies. Using “Out of Network” providers will cause you to pay higher medical bills. - Part D: (Prescription Drug Coverage) - This can be purchased separately with Original Medicare or a Medicare Supplement. You must have a Part D plan or face possible lifetime penalties if and when you finally decide to enroll in a Part D plan.
-
Medicare Supplement Plan (Medicare Pays Most & Insurance Company Pays Rest or Part) - Includes medical coverage only and premiums vary by age. Plan can be used nationwide at any hospital or with any doctor who accepts Original Medicare. Prescription drug coverage is not included.
Medicare is still the primary payer of your medical claims but the insurance company (Supplement) also pays some or all of the costs that Medicare does not cover. (Deductible, Coinsurance, etc)
If you enroll when first eligible at age 65, there are no medical questions to answer and you are “guaranteed enrollment” into the plan. You may switch to another Supplement after this time, however, medical questions will be asked and you can be denied enrollment or pay higher premiums to enroll.