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FAQ's - Medicare Coverages

I Am Confused By The Various Parts of Medicare.

Medicare consists of four parts: Part A covers hospital insurance, Part B covers Medical insurance, Part C is offered through insurance companies and offers an alternative to Medicare Supplement policies, and Part D is offered through insurance companies to provide prescription drug coverage.

For most people, there is no charge for Part A, but you must pay for Part B. You are also responsible for the premiums whether you elect Part C Medicare Advantage or a Medicare Supplement. You are also responsible for the premiums and copayments for Part D prescription drug coverage.

It is important to know that if yo do not elect certain parts of Medicare when you are first eligible, you will be subject to a penalty for late enrollment. The following link provides a good overview, which benefits you should apply for, when and where to apply, and which parts have penalties for late enrollment:

When Should I Enroll in Medicare?

Although the age to receive full Social Security retirement benefits is gradually being raised, individuals turning 65 should still enroll for Medicare. You are eligible for Medicare benefits the first of the month in which you turn 65 even if your birthday isn’t until the end of the month. You can enroll in Medicare the three months before your birthday, the month of your birthday, and three months after. If you wish to have Medicare benefits when you turn 65, you should apply in the three months before your birth month.

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I’m Covered by Medicare – Do I Need Additional Coverage?

Medicare doesn’t cover everything and if you need a service not covered by Medicare, you will need to pay for it yourself unless you have other  health insurance that will cover it. Even if Medicare Parts A and B cover a service, you are responsible for your deductible, coinsurance, and copayment. Under Medicare there is no limit to your maximum out-of-pocket. For this reason, most people insure themselves to cover the deductible and coinsurance. Your choices to supplement Medicare are a Medicare Supplement or Medicare Advantage plan.

Medicare also does not cover prescription drugs. To get Rx coverage, you must join a plan offered by an insurance company approved by Medicare. There are two options to get prescription drug coverage: through a Part D plan offered by insurance companies or through a Medicare Advantage (Part C) plan which is also offered by insurance companies. Regardless of which option you choose, you must be enrolled for Medicare Part A and B in order to be eligible for Part C or D. If you don’t elect prescription drug coverage when you are first eligible, you’ll likely pay a late enrollment penalty.

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What if I am Still Working and Covered by my Employer’s Group Health Benefits?

You should first check with your employer’s plan administrator. You may be able to choose either your group plan or Medicare Parts A and B with a Medicare Supplement and Part D  or with a Medicare Advantage Plan. If you remain covered under your employer’s group plan, you can delay enrolling in and paying for Part B until you need it.

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Are the Medicare Supplement and Part C Medicare Advantage Plans All the Same?

No. The Medicare Supplement plans are standardized with the same plan name and benefits available in  all states except Massachusetts, Minnesota, or Wisconsin. Thus a Plan F will have the same benefits regardless of which company you purchase from. The differences will be in the premium they charge and their underwriting requirements.

Part C Medicare Advantage plans can vary greatly. They are approved on a county-wide basis and may not be available in all counties. Medicare approves these plans annually prior to Open Enrollment. With a Medicare Advantage plan, the premium and benefits will vary by company and county. Some plans will offer additional benefits such as vision, hearing aids, and health clubs memberships among others.

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What is the Difference Between the Different Part D Prescription Drug Plans?

Each plan has their own list of drugs that they cover, commonly known as their formulary list. Depending on which medications you take, your drug may be on one company’s formulary list, but not on another. That is why it is important to run your medications through the calculator on the Medicare website to be informed about which plan is most advantageous for you (the REGIT staff will be happy to help you with this). Each company’s plan design can also vary in the amount of the deductible (if any) and the copay or coinsurance, as well as the premium.

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What is the Open Enrollment Period I’ve Read About?

Each year between October 15 and December 7 you have an opportunity to enroll in or change Part C Medicare Advantage or Part D Prescription drug plans. Each year you should review your personal situation to see if moving to another plan will be beneficial to you. This is especially important if your medications have changed. When you enroll in a Part C Medicare Advantage or Part D prescription drug plan, you generally are committed to that plan for one year (subject to limited exceptions). Medicare Supplement plans are not subject to open enrollment periods and you can change at any time you choose, although you may be subject to underwriting.

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What is the Difference Between Medicare and Medicaid?

Although some people think that Medicare and Medicaid are the same, they are actually very different programs. Medicare is generally for people over 65, although some disabled people under 65 qualify for Medicare. Medicaid is a state-run program that provides medical and hospital coverage for people with a low income and little or no resources. Because Medicaid is run by the state, each state has their own rules about who is eligible and what is covered by Medicaid. You can call your state Medicaid office for more information.

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