Medicare Beginner’s Guide: Welcome to a New World of Health Insurance
While you may not feel like much of a beginner at anything as you approach your 65th birthday, you will likely want a Medicare beginner’s guide. That’s because Medicare is unlike any health insurance coverage you have ever had. The terms are new, the programs are unique, the options are plentiful, and the process for enrollment often proves different or even difficult.
But understanding the basics of Medicare health insurance is an essential first step if you want to maximize the benefits you receive from this valuable program. Once you get a lay of the land, an experienced Medicare broker in Arizona can help ensure you get the coverage you need at the lowest possible cost.
Medicare Beginner’s Guide Answers the Question: What Is Medicare?
Established in 1965, Medicare is a federal program designed to pay most healthcare costs for Americans 65 or older, as well as for those younger than 65 who have certain disabilities. Eligibility for Medicare does not relate to your income, assets, or wealth. That distinguishes Medicare from Medicaid, a state and federally funded healthcare program that provides medical assistance and care for low-income individuals.
While Medicare will pay for the lion’s share of your medical costs, you will likely still need to pay premiums, deductibles, coinsurance, and copays for much of the treatment and care you receive. However, you can enroll in private Medicare supplemental insurance plans in Arizona — called Medigap plans — to help you fill in these gaps in Medicare coverage.
The ABC’s (and D’s) Of Medicare
Like learning the alphabet, learning about Medicare begins with the ABC’s – and D’s. Medicare has four distinct parts, each of which covers different things and involves unique issues:
Medicare Part A
This part of Medicare covers inpatient hospital stays, skilled nursing facility stays, some home health visits, and hospice care.
Part A inpatient hospital benefits are subject to a deductible of $1,408 in 2020, which covers the participant’s share of costs for the first 60 days of inpatient hospital care in a benefit period. For days 61 through 90 of inpatient care, beneficiaries must pay a coinsurance of $352 per day. For individuals in skilled nursing facilities, the daily coinsurance for days 21 through 100 of extended care services is $176.00. While some individuals may have a premium for Part A coverage, 99 percent of Part A participants do not have to pay a premium since they have at least 40 quarters of Medicare-covered employment.
Medicare Part B
This Medicare program covers doctor’s visits, outpatient treatment, preventive care services, and some home health visits. A deductible applies to many Part B benefits ($198 in 2020), and, typically, you will pay a coinsurance of 20 percent as well. You won’t pay coinsurance or deductible for an annual wellness visit or for preventive services rated ‘A’ or ‘B’ by the U.S. Preventive Services Task Force, such as mammograms or prostate cancer screenings.
Medicare Part C
Part C refers to Medicare Advantage, which is Medicare-approved private insurance plans. These plans combine coverage for hospital care, doctor visits, and other medical services in one comprehensive plan that provides all of the benefits offered by Medicare Parts A and B (except hospice care). Many Medicare Advantage plans also offer prescription drug coverage and other benefits like routine vision and dental care.
Medicare Part D
Established in 2006, Part D covers outpatient prescription drugs through private plans that contract with Medicare, including stand-alone prescription drug plans (PDPs) and plans with prescription drug coverage (MA-PDs). Medicare beneficiaries can choose from a wide range of PDP and MA-PD plans, with cost-sharing and premiums varying by plan. Participation in Part D is optional.
Enrolling in Medicare
Just like receiving an AARP card as a birthday present most of us get in the mail when we turn 50, a Medicare card is the gift we receive as we approach 65. Generally, you can enroll in Medicare:
- When you turn 65, no matter your spouse’s age;
- Regardless of whether you are collecting Social Security benefits yet; and
- Even if you work past age 65 and keep your employer coverage or have coverage through your spouse’s employer.
Enrollment in Medicare is automatic for some folks, but not for everyone. The government will enroll you in Medicare Parts A and B automatically, and you will receive your Medicare card in the mail, if:
- You are turning 65 and are receiving Social Security or Railroad Retirement Board benefits.
- You are under 65 and have received disability benefits for 24 months.
- You have Lou Gehrig’s disease (ALS) and start getting disability benefits.
If you do not fit into one of the above categories, you will need to enroll yourself during what’s called the Initial Enrollment Period (IEP). Typically, your IEP starts three months before your 65th birthday and ends three months after. While you can still enroll in Medicare after the end of your IEP, there are penalties involved.
This Medicare Beginner’s Guide Just Scratches The Surface – We Can Fill in the Blanks
Medicare can seem complicated, and the information you need to review and understand to make the right coverage choices can be overwhelming. But it’s not a journey you need to undertake alone.
An experienced, independent Medicare broker can handle all of your Medicare needs. From selection to enrollment to education and more, a good broker can help you make informed decisions that will provide you with the coverage best suited to your needs.
Since 1981, our independent Scottsdale based Medicare brokers at Anderson Insurance Services have helped thousands of Arizona seniors understand Medicare’s complexities, providing insights, guidance, and resources they can rely on.
Anderson Insurance Services remains committed to answering your questions, addressing your concerns, and providing solutions that can keep you safe and healthy during these challenging times. In response to COVID-19, we have ensured that we can handle quotes and enrollment via video conferencing, telephone, and email.
Contact us to schedule a free consultation about your Medicare questions and needs.