Medicare is Crazy Complicated, Right?!
What is Medicare?To put it simply, Medicare is a national health insurance program for those 65 years and older in the United States. Some people receiving Social Security disability can even enroll into Medicare before turning 65. Enrolling into Medicare isn’t just one piece, though! The whole Medicare program is actually segmented into different sections, known as Parts. It is vital to know how all these fit together so you can get the most of your Medicare plan.While Medicare is complicated at times, you deserve to be treated with respect when it comes to your care and any questions you may have. It is essential to understand how your coverage works, so you can live your life to the fullest without having to worry too much over healthcare costs.
Medicare’s History in the United States
What Are the Parts of Medicare?
- Care you receive when admitted to the hospital as an inpatient after an official doctor’s order
- Skilled nursing facility care
- Hospice care
- Home health care
- Medically required services or supplies used to diagnose or treat medical conditions
- Preventive services: Health care used to deter an illness or detect it at an early stage
- Care you receive when you’re admitted to a hospital as an inpatient through a doctor’s official order.
- Any skilled nursing facility care.
- Any hospice and home care.
Both Medicare Part A and Part B is vital to you, as it is your Medicare coverage for both medically necessary and preventative services. When you receive medical services outside of the hospital- often even inside the hospital- Medicare Part B is in charge of covering these services.Unlike Medicare Part A, there is a monthly premium to enroll in Medicare Part B. The amount of this premium is set by Social Security and can change on a yearly basis. In 2021, the standard Part B premium is $148.50 per month. However, your Medicare Part B premium can actually increase based on your tax bracket. The increased amount you may pay for your Medicare Part B premium is referred to as your Income Related Monthly Adjusted Amount (IRMAA) and is based on your Modified Adjusted Gross Income (MAGI).Not only does Medicare Part B have a monthly premium, it also has an annual deductible and coinsurances. The Medicare Part B annual deductible in 2021 is $203. Once you have met your Part B annual deductible, your Medicare Part B coverage is now at an 80/20 split, where Medicare Part B covers 80% of medically necessary services, leaving you responsible for 20%. Unfortunately, that 20% has no stop to it! Just like with Medicare Part A, it is essential to enroll in something like a Medicare Supplement plan to limit these costs, which will be discussed further down below.You do need to sign up for Part B when you are ready to enter Medicare. A lot of people get confused by this because you need to contact Social Security to sign up for Medicare. The good news is most people can do it online by visiting here.For a more straightforward look at Medicare Part B:
- Preventative services are used to deter illness or detect illness at an early stage.
- Services medically necessary, or any supplies used to diagnose or treat your medical conditions.
- Medicare Part C: Unlike Medicare Parts A and B, you don’t have to go to Social Security to enroll in Medicare Part C.Medicare Part C is defined as a Medicare Advantage program, or to put it simply, private insurance. This cost of these plans will vary by the insurance provider, your residential county, and the plan you have selected.If you are interested in registering in a Medicare Part C plan, you must make sure you are already enrolled in Medicare A and B. However, if you find a plan for Part C that gives you a low premium cost, you’ll still pay for Part B. Living in the plan service area is also a must. Medicare Advantage plans generally have a network of doctors and hospitals that need to be used. This is usually one of the loudest complaints regarding Medicare Advantage plans. After you enroll, your Medicare coverage will no longer come from the government, but from the Advantage plan (insurance company) itself. This means your Part C coverage will pick up the expenses. One main reason that enrollment at Social Security isn’t required is that the enrollment is strictly voluntary and not part of the Federal government.Although many Medicare Advantage plans can offer low, sometimes zero dollar per month premiums, that doesn’t mean that these plans are free! Medicare Advantage plans frequently involve out-of-pocket maximums that can reach as high as $7,500 in 2021. This means that as you use your plan, you are still going to be paying out-of-pocket for many services and procedures. It is a pay-as-you-go model.
Medicare Supplement Plans (Medigap)
Does Medicare Cover Outside the United States?
Original Medicare does not offer coverage when you travel outside the US. This may come as a surprise to many as they make travel plans. The good news is that Medicare supplement plans do offer some coverage when you are traveling. Make sure to discuss with your agent so you know exactly what your benefits are.
What Medicare Doesn’t Cover
The Difference Between Medicare and Medicaid
If you’ve asked about the difference between Medicare and Medicaid, you aren’t alone. It’s a common question. Medicare is a tax-payer funded government health insurance program for those 65 years and up. Medicaid, however, is healthcare and/or financial assistance to those individuals with low income. Many individuals 65 and up can qualify for both. If this the case with you, keep in mind that Medicare is your primary insurance with Medicaid being your secondary.
To help you financially, the government provides many savings programs that you can apply for. This is done through the Medicaid office in your state. This program may help you in paying your Medicare Part B premiums and can also assist in your drug plan. If you are wondering if you qualify for the Medicaid program, check with your local Medicaid office.
So What to Do?
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Whether you’re someone well-versed in all things regarding healthcare or are a total newbie, health insurance can be an incredibly confusing topic. Medicare is no
There are several parts of Medicare, and for each one, there are changes in both the premiums and out-of-pocket costs for Medicare beneficiaries that happen