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Medicare Explained

Your medicare questions answered. Including: Do I qualify? How do I enroll? And What does it cover?

What is Medicare?

Medicare is a government program that helps to provide health insurance for people who qualify based on age, disabilities and End-Stage Renal Disease. This federal health insurance is the United State’s health insurance program for people age 65 or older. It helps with health care costs, however it does not cover all medical expenses.

Typically plans are offered by a private company contracted by Medicare to offer specific coverage and benefits to those enrolled in Medicare. The health plans offered by Medicare include Medicare Advantage plans, Medicare medical savings account plans, and other Medicare health plans including Medicare cost plans, demonstration or pilot programs, programs for all-inclusive care for the elderly (also known as PACE) and medication therapy management programs for those who have complex health needs.

What do Medicare plans cover?

Medicare is broken up into four parts of coverage: parts A, B, C and D.

  • Medicare Part A is hospital insurance and offers coverage for care such as hospital stays, home health care, hospices and staying in a skilled nursing facility.
  • Medicare Part B is medical insurance for doctor’s services, preventative services and outpatient care.
  • Medicare Part C, known as Medicare Advantage plans, are health plans offered by a private company that contracts with Medicare in order to provide Part A and B benefits. These plans typically offer prescription drug coverage.
  • Medicare Part D provides prescription drug coverage to those who already use Medicare. Prescription coverage plans through Medicare are offered by private or insurance companies who are approved by Medicare, although some Medicare Advantage Plans do offer prescription coverage in it.

How can you tell if you qualify?

Rather than going through the lengthy application process, it is best to determine if you’re eligible for Medicare before trying to apply. To check on this, us a Medicare eligibility calculator to determine if you qualify and what your premium amount would be. It will also tell you whether or not you will get Medicare Part A or Part B automatically or if you need to sign up.

The calculator can provide information for most situations, however not every situation is listed. If your specific situation is not on the calculator, you can determine your eligibility by contacting Social Security and verifying through them.

How can you apply and register?

In order to use Medicare, follow these steps to begin the process and determine a health plan that works for you.

First, check your Medicare eligibility. If you do not automatically get Medicare, apply to use the federal health insurance program online.

Next, choose what type of coverage is right for you. Look at the specific Medicare coverage parts, specifically what Part A and Part B provide in terms of coverage, and decide whether you want Part B. The two main ways to get Medicare coverage is with Original Medicare or with a Medicare Advantage Plan. You also have the option of getting additional coverage if you decide you need Part D, or prescription drug coverage. If you already have other health insurance, Medicare can still work with your current insurance, including if you have coverage from a previous employer.

Once you’ve made a decision about what type of coverage would best suit your needs, you must fill out the Initial Enrollment Questionnaire (IEQ). An IEQ will arrive in the mail about three months before Medicare coverage is set to begin. If will ask about supplementary health insurance you might have that can cover costs before Medicare does. The IEQ helps to make sure bills are paid on time and correctly, so it is important for both yourself and for Medicare that this is taken care of immediately.

When should I sign up for Medicare?

Whether or not you plan on using Medicare, it’s a good idea to sign up for Medicare three months prior to your 65th birthday. Almost all people who are 65 years old or older are eligible for Part A and it’s wise to sign up whether or not you want to receive those retirement benefits right away. The same goes for Part B. If you do not sign up right away and do so later, coverage can be delayed or cost more, unless you will later become eligible for a Special Enrollment Period. Initial enrollment for Medicare starts three months before the month you turn 65 and ends three months following the month in which you turn 65.

If your medical insurance is under a group health plan, applying for Medicare Part B may not be necessary right away. If qualified for a Special Enrollment Period, you can sign up at any time while you’re still covered under the group health plan or during the eight month time-frame that your group health coverage ends. It’s important to note that if your group health coverage ends during your initial enrollment period for Medicare Part B, you will not qualify for a Special Enrollment Period.

Don’t Forget...

During your first year with any new health insurance provider, figuring out how to navigate the system, setting up preferences for notices and even figuring out how to access information can be confusing. There are ways to make the transition into Medicare more convenient during the first year.

If you want friends or family to call or contact Medicare on your behalf, Medicare must have written consent to discuss your personal health information. Be sure to fill out an authorization form so when the time comes, they can easily access and help you with any Medicare needs or issues you have.

Once you are signed up for Medicare, you receive a free, one-time Welcome to Medicare preventative visit to help you learn more about Medicare and your own health. Schedule this early on, or at least within the first 12 months of enrollments, to make sure you feel in control of your health.

If you would rather use a website than call in to a provider, signing up for MyMedicare.gov and familiarizing yourself with the site is a great way to ensure access to Medicare information online. It allows you a number of conveniences, including the ability to track health care claims, order replacement medicare cards and even view your eligibility information. By taking care of this early on, you won’t have to worry about figuring out how to work the website at the same time that you’re trying to track claims and deductibles.

If you’re still not sure if you should use Medicare or another insurance provider, contact your Arizona State Health Insurance Assistance Program where you are able to get personalized health insurance counseling for free, or use your current Arizona health insurance provider to give you more insight into Medicare.

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