Looking for answers to some of your Medicare questions? Here, I answer some basic questions about Medicare benefits, including who can avail it, what it covers, and how much it costs.
In this article:
Answers to Frequently Asked Medicare Questions
Medicare Coverage Questions
Who Is Covered by Medicare?
According to the U.S. Department of Health and Human Services, Medicare is generally available for:
- People who are over 65 years old
- Those who are younger than 65 and have permanent kidney failure and require transplant or dialysis
- Those who are younger than 65 who have disabilities
One common misconception about Medicare eligibility is that people who start receiving Social Security benefits can also claim Medicare benefits. Specifically, some retirees enjoy an early retirement at 62, which is the earliest age to start claiming Social Security retirement.
However, this is false since Medicare only starts at 65. Anyone planning for retirement, especially an early retirement, should take this into consideration.
A retiree may get an automatic enrollment in the Medicare program for benefits when they applied for Social Security upon age 65. Those who are 65, or will turn 65 within the next three months, and haven’t received Social Security benefits can apply for Medicare online.
Does Medicare Cover Long-Term Care Insurance for Retirees?
What Medicare does cover is short-term care, such as a short respite or recovery in a nursing home following an operation.
Medigap plans are an extended insurance product offered by private companies. These insurance plans are meant to cover any coverage gap that Medicare won’t cover, and each insurer may have varying costs of premiums, deductibles, and provisions.
If you don’t have a long-term care insurance plan, you may want to think about it or at least talk to a financial advisor since Medicare won’t cover long-term care.
Long-term care insurance pays not just for any day-to-day living service expenses but also the costs associated with the facility.
A sudden need for long-term care services may deplete your retirement savings and can lead to debts. Avoiding debts during retirement is immensely important, and living a debt-free retirement is a goal any retiree should aim for.
Some retirees may also need long-term care due to:
- An injury
- Any form of a diagnosed disability
- Cognitive impairment
- Any status that requires help or supervision for their day to day living
What Are My Choices for Medicare Coverage?
You have two options for Medicare coverage: Original Medicare Plan and Medicare Advantage Plan. These are what are commonly known as Medicare Parts, with the former corresponding to Parts A and B and the latter corresponding to Part C.
Part C includes both Part A and B and can be obtained through private companies. Most Advantage plans also offer Part D, which refers to the Prescription Drug Plan.
Part A, also known as “Hospital Insurance (HI),” covers:
- Inpatient care in a hospital
- Skilled nursing care, specifically the first 20 days as short-term care
- Hospice care
- Home health care
On the other hand, Part B, which is also known as “Medical Insurance,” covers:
- Ambulance services
- Inpatient, outpatient, and part of hospitalization for mental health
- A second opinion before getting a surgical operation
- Limited outpatient prescription drugs
- Clinical research
- Durable medical equipment
- Medically necessary services
- Preventive services
On the other hand, these products and services aren’t covered:
- Hearing aids and related tests
- Eye examination for getting glasses
- Cosmetic Surgery
- Routine foot care
- Most dental care
- Long-term care
How much coverage you can get depends on:
- Federal and state law
- Coverage decisions by companies working with Medicare, specifically deciding whether a medical service, drug or anything claimed should be covered in a locality
- National coverage decisions made by Medicare
Medicare Billing Questions
How Much Does Medicare Cost and How Much Does It Cover?
As long as you’re eligible for the Premium-Free Part A scheme, you don’t have to pay premiums for Part A.
However, anyone who has a Part A claim must pay a deductible of $1,364. Specifically, Medicare beneficiaries pay $341 for 29 days after the 60 days covered by Medicare.
That brings to 90 days of coverage, with 60 days having one deductible of $1,364. From there, it’s $341 per day until the 90th day. For days beyond that, there’s a $682 coinsurance for each “lifetime reserve day” for each benefit period.
The premium for Part B currently stands at $135.50, an increase of $1.50 per month from the 2018 premium.
The insured pays a deductible of $185 first. Once the insured reaches the deductible, Medicare pays for 80%, with the remaining 20% shouldered by the insured.
Important to note: Not enrolling for Part B when you’re first eligible will lead to a late enrollment penalty on Medicare Part B premiums. For more specific information about Part B eligibility, you can reach the Medicare office through 1-800-633-4227.
Part C and D depends on what your private insurance policy carries.
As you can see, Medicare rarely pays for the whole coverage of medical needs. Since we may need more care the older we get, preparing for sickness and injuries during retirement is a must.
Other Questions About Medicare
If I Have Health Insurance While I Am 65, Do I Need to Opt-In Medicare?
Actually, a worker does not need to opt-in to medicare:
- If the primary insured, which can be you or your spouse, is still working under the employer,
- The employer has at least 20 employees, and
- You still have coverage from the employer.
If you no longer work for that employer, you need to sign up to Medicare as soon as you are qualified. Remember, non-enrollment to Medicare upon qualification can lead to 10% Part B premium for every year you have not enrolled.
How Does Medigap Compare to Traditional Medicare?
A Medigap plan can serve as a Medicare supplement plan since it’s insurance offered by private companies that will cover what Medicare won’t. The latter doesn’t cover everything since there’s usually a deductible that still applies to the insured.
However, a reminder about Medigap: please note some insurance companies will still ask for premiums during your retirement so financial planning and shopping for rates is absolutely necessary.
Generally, a long-term care insurance policy can help offset out-of-pocket expenses as well as having separate health insurance. Ideally, the long-term care policy covers the stay and the health insurance covers medicine and services.
Talking to an insurance company about possibly combining both health and long-term care can definitely make retirement more convenient.
Another option to think about lies with working during retirement. Working for a charity or having a job even during retirement can also help through insurance programs offered by the employer.
Answering Medicare questions as early as possible can make retirement planning a lot easier. By planning ahead for any Medicare issues that may arise, you can have a more solid plan.
Do you have other questions about Medicare? Let us know in the comments section below.
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