Why Do I Need To Buy A Private Health Plan
Private Medicare health plans like Medicare Advantage or Medicare Cost plans cover everything Original Medicare does, and usually include more coverage for services you might need. Plus, they can include extra perks and benefits.
Find out more in the article, 4 reasons to buy a private health plan.
What To Tell Clients About Original Medicare
Clients going on Medicare have reached a major milestone. You can help them make the most of it.
The year before someones 65th birthday is a great time for financial advisors to start talking about Medicare with clients. Starting Medicare may seem confusing and overwhelming for your clients, especially as they get inundated with insurance solicitations in the mail!
This article focuses on original Medicare, also called traditional Medicare, which is run by the federal government. The other option some clients may want to consider is Medicare Advantage, run by private insurers paid by the federal government. Advantage plans may work for some clients, particularly those who cant afford the monthly cost of original Medicare. However, for those who can afford it and want broad access to doctors, original Medicare is usually the best choice.
Here are some questions that clients may ask you at various steps in the process about Medicare and the answers you will want to provide.
Step 1: Initial Enrollment
When should I enroll?
Although youll have a seven-month window to enroll in Medicare, in most cases youll want to enroll at the beginning of that period: three months before your 65th birthday. If you dont already have one, create an account at the Social Security Administration, which runs Medicare. If you want to stay on employer-sponsored health insurance, you should check with Medicare to see if youll face penalties for signing up later.
Step 2: Understanding the Cost
Do I Have To Change Medicare Doctors If Mine Isnt In My Provider Network
As long as your current doctor accepts Medicare, you should be able to see them and receive coverage for the visit. However, if they decide not to accept Medicare or stop participating in the program, you will need to find another doctor.
If youre joining a Medicare Advantage plan, you can contact the insurance company directly to find out if your preferred doctor is covered in the network. If not, you can either choose a new doctor or a new insurance provider.
Read Also: Do You Have To Take Medicare Part B
What Are My Costs
- Original Medicare
- For Part B-covered services, you usually pay 20% of the Medicare-approved amount after you meet your deductible. This is called your coinsurance.
- You pay a premium for Part B. If you choose to join a Medicare drug plan, youll pay a separate premium for your Medicare drug coverage .
- There’s no yearly limit on what you pay out of pocket, unless you have supplemental coveragelike Medicare Supplement Insurance .
- Medicare Advantage
- Out-of-pocket costs varyplans may have different out-of-pocket costs for certain services.
- You pay the monthly Part B premium and may also have to pay the plan’s premium. Plans may have a $0 premium or may help pay all or part of your Part B premium. Most plans include Medicare drug coverage .
- Plans have a yearly limit on what you pay out of pocket for services Medicare Part A and Part B covers. Once you reach your plans limit, youll pay nothing for services Part A and Part B covers for the rest of the year.
Your Original Medicare Premium Payments
They affect all of your Medicare coverage
To maintain continuous health coverage, make sure you always pay your Original Medicare monthly premiums on time. Many beneficiaries donât pay a Medicare Part A premium â you donât have to pay this premium if you worked at least 10 years while paying Medicare taxes. However, most beneficiaries must pay a monthly Medicare Part B premium, even if theyâre enrolled in Medicare Advantage or another Medicare plan option
If you receive Social Security, Railroad Retirement Benefits , or Civil Service benefits, your Medicare premium may be automatically deducted from those benefits. In other cases, you may have to make the Medicare payment yourself when you receive your monthly bill, or choose one of the payment options described below.
You can pay your Original Medicare premium in one of three ways: Sign up for Medicare Easy Pay, which is free and automatically deducts the premium payment from your checking or savings account pay by check or money order or pay by credit card.
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Is There A Copay With Medicare
- Medicare is a government-funded health insurance option for Americans age 65 and older and individuals with certain qualifying disabilities or health conditions.
- Medicare beneficiaries are responsible for out-of-pocket costs such as copayments, or copays for certain services and prescription drugs.
- There are financial assistance programs available for Medicare enrollees that can help pay for your copays, among other costs.
Medicare is one of the most popular health insurance options for adults age 65 and older in the United States. When you enroll in Medicare, you will owe various out-of-pocket costs for the services you receive.
A copayment, or copay, is a fixed amount of money that you pay out-of-pocket for a specific service. Copays generally apply to doctor visits, specialist visits, and prescription drug refills. Most copayment amounts are in the $10 to $45+ range, but the cost depends entirely on your plan.
Certain parts of Medicare, such as Part C and Part D, charge copays for covered services and medications. Deductibles, copays, and coinsurance fees all contribute to the out-of-pocket maximums for these plans.
In this article, well explore the parts of Medicare that charge copay fees, how to compare copay costs when enrolling in a Medicare plan, and how to find help paying your out-of-pocket costs.
How Do I Choose The Right Coverage For Me
Determining your current and anticipated medical needs can help you create a roadmap to help you choose coverage. Consider the following issues as you decide:
- Prescription drugs. Even though Medicare Part D is voluntary, it is important to consider your prescription medication needs. Signing up for Part D, or for an Advantage plan that includes medications, may save you money in the long run.
- Vision and dental needs. Because these arent covered by original Medicare, it may make sense for you to buy a plan that provides this coverage.
- Budget. Plan out your anticipated monthly and annual budget after retirement. Some plans have low monthly premiums, which make them attractive. However, these plans often have higher copays. If you have a lot of doctor appointments during an average month, add up what your copays will be with a $0 premium plan before you buy.
- Chronic conditions. Keep in mind any known chronic condition or one that runs in your family, as well as upcoming procedures you know will be needed. If you are comfortable using in-network doctors, going with a Medicare Advantage plan might make the most sense for you.
- Travel. If you travel extensively, opting for original Medicare plus Medigap may be a good option. Many Medigap plans pay for a large portion of emergency medical services you may need when traveling outside the United States.
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What Are The Benefits To Medicare Advantage
Medicare Advantage covers more than Medicare , allowing patients more options and flexibility. Patients can customize their Medicare Advantage to cover specific needs like wheelchair ramps, adult day care, and respite care. Additionally, the 2020 CARES Act expanded Medicare’s network to cover more telehealth services.
What Is Medicare Part A Hospital Insurance
Medicare Part A covers the following services:
- Inpatient hospital care: This is care received after you are formally admitted into a hospital by a physician. You are covered for up to 90 days each benefit period in a general hospital, plus 60 lifetime reserve days. Medicare also covers up to 190 lifetime days in a Medicare-certified psychiatric hospital.
- Skilled nursing facility care: Medicare covers room, board, and a range of services provided in a SNF, including administration of medications, tube feedings, and wound care. You are covered for up to 100 days each benefit period if you qualify for coverage. To qualify, you must have spent at least three consecutive days as a hospital inpatient within 30 days of admission to the SNF, and need skilled nursing or therapy services.
- Home health care: Medicare covers services in your home if you are homebound and need skilled care. You are covered for up to 100 days of daily care or an unlimited amount of intermittent care. To qualify for Part A coverage, you must have spent at least three consecutive days as a hospital inpatient within 14 days of receiving home health care.
- Hospice care: This is care you may elect to receive if a provider determines you are terminally ill. You are covered for as long as your provider certifies you need care.
Keep in mind that Medicare does not usually pay the full cost of your care, and you will likely be responsible for some portion of the cost-sharing for Medicare-covered services.
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The Parts Of Medicare
Social Security enrolls you in Original Medicare .
- Medicare Part A helps pay for inpatient care in a hospital or limited time at a skilled nursing facility . Part A also pays for some home health care and hospice care.
- Medicare Part B helps pay for services from doctors and other health care providers, outpatient care, home health care, durable medical equipment, and some preventive services.
Other parts of Medicare are run by private insurance companies that follow rules set by Medicare.
- Supplemental policies help pay Medicare out-of-pocket copayments, coinsurance, and deductible expenses.
- Medicare Advantage Plan includes all benefits and services covered under Part A and Part B prescription drugs and additional benefits such as vision, hearing, and dental bundled together in one plan.
- Medicare Part D helps cover the cost of prescription drugs.
Most people age 65 or older are eligible for free Medical hospital insurance if they have worked and paid Medicare taxes long enough. You can enroll in Medicare medical insurance by paying a monthly premium. Some beneficiaries with higher incomes will pay a higher monthly Part B premium. To learn more, read .
Am I Automatically Enrolled In Medicare Part B
If you receive Social Security or Railroad Retirement Benefits for at least four months before you turn 65, youll automatically get Medicare Part B. Youll get your Medicare card in the mail, along with more information about your benefits. When youre automatically enrolled in Medicare, your Part B monthly premium is typically deducted from your Social Security or RRB payment.
If you are not receiving Social Security or Railroad Retirement Board benefits when you turn 65, you may have to enroll in Medicare Parts A and B yourself.
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Are You Automatically Enrolled In Medicare
You may be enrolled automatically in Original Medicare if you qualify under these two scenarios:
Contact Medicare by phone three months before your scheduled start date to make sure the correct enrollment options are in process.
What Is Original Medicare
Original Medicare was signed into law by President Johnson in 1965. Original Medicare provides healthcare coverage to eligible beneficiaries for both inpatient and outpatient services at medical facilities nationwide and is a fee-for-service plan that is managed by the federal government.
Since its inception in 1965, Original Medicare has consisted of the same two parts. Medicare Part A and Medicare Part B. For more than 50 years, Original Medicare has provided coverage for Seniors and Americans with disabilities.
With Original Medicare, you can go directly to the doctor or hospital of your choice, bypassing prior authorizations or referrals. The government is responsible for paying its portion directly to your provider and you cover the left-over costs. The only qualification for care is that the doctor you choose accepts Medicare.
Find Medicare Plans in 3 Easy Steps
We can help find the right Medicare plans for you today
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Improve Medicare For All Beneficiaries
Medicare is extremely popular, but it needs attention to ensure all beneficiaries receive comprehensive coverage and equitable treatment. The Medicare program that Americans know and cherish has been allowed to wither. Traditional Medicare, preferred by most beneficiaries, has not been improved in years, yet private Medicare Advantage plans have been repeatedly bolstered. Its time to build a better Medicare for all those who rely on it now, and will in the future.
How Much Do Part C Part D And Medigap Cost
Medicare Part C, Part D, and Medigap all have varying costs based on your county, ZIP code, and the plan provider you choose.
These plans are purchased through private insurance companies but are required to follow federal guidelines. For that reason, there are caps on associated costs, such as your out-of-pocket maximums, deductibles, and monthly premiums.
For example, for Medicare Part C, your maximum out-of-pocket annual limit for in-network providers is $7,550. If you use both in-network and out-of-network providers, your maximum out-of-pocket annual limit is $10,000.
Many Part C plans have a $0 premium. Others can go as high as $200 a month, or more, which is in addition to your monthly Part B premium.
Medicare requires you to use Medicare-approved providers and suppliers when you seek medical care. Most doctors in the United States accept Medicare, but there are exceptions. Its always important to ask if your doctor takes Medicare when you make an appointment.
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Find Out What Medicare Plan May Fit Your Needs
Did you know that you could potentially find a Medicare Advantage plan with $0 premiums, $0 deductibles and an annual out-of-pocket spending max?
$0 premium plans may not be available in all locations, so it may be helpful to speak with a licensed insurance agent who can help you compare plans where you live.
Or call 1-800-557-6059TTY Users: 711 to speak with a licensed insurance agent. We accept calls 24/7!
About the author
Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles hes written, helping Americans better understand their health insurance and Medicare coverage.
Christians work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelors degree in journalism.
Medicare has neither reviewed nor endorsed this information.
Am I Automatically Enrolled In Medicare Part A
If youre getting Social Security benefits or RRB benefits for at least four months before turning 65, youre automatically enrolled in Medicare Part A. You dont need to sign up for Medicare. Just check the mail for your Medicare card and start using Medicare coverage on the first day of the month you turn 65.
If you are turning 65 and not on Social Security, you may be auto enrolled in Medicare Part A. You can check by contacting the Social Security Administration at 772-1213, or logging into your my Social Security account. If you dont have a my Social Security account, you can sign up at SSA.gov.
If you or your spouse paid Medicare taxes when working, you may qualify for premium-free Part A.
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Checking Your Medicare Application Online
Many Americans retire when they turn 65 and are not yet collecting Social Security benefits. If you keep working until 65, youll need to submit a Medicare application. Start by finding the Medicare application on the Social Security website. The application process is completely free, and you can fill out the entire application online.
Once youve applied for Medicare, you can check your Medicare application status online or over the phone. There are several ways to do so:
- Log into your Social Security account to check the status of your application
- Log into your Medicare Account and visit the check enrollment page to see the status of your application
When you check your application status online, youll see:
- The date you applied.
- The address of the local Social Security office thats processing your application.
- Any requests for additional documents.
- The date your application is approved.
Who Is Eligible For Medicare
Generally, Medicare is available for people age 65 or older, younger people with disabilities and people with End Stage Renal Disease . Medicare has two parts, Part A and Part B . You are eligible for premium-free Part A if you are age 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years. You can get Part A at age 65 without having to pay premiums if:
- You are receiving retirement benefits from Social Security or the Railroad Retirement Board.
- You are eligible to receive Social Security or Railroad benefits but you have not yet filed for them.
- You or your spouse had Medicare-covered government employment.
To find out if you are eligible and your expected premium, go the Medicare.gov eligibility tool.
If you did not pay Medicare taxes while you worked, and you are age 65 or older and a citizen or permanent resident of the United States, you may be able to buy Part A. If you are under age 65, you can get Part A without having to pay premiums if:
- You have been entitled to Social Security or Railroad Retirement Board disability benefits for 24 months.
- You are a kidney dialysis or kidney transplant patient.
While most people do not have to pay a premium for Part A, everyone must pay for Part B if they want it. This monthly premium is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you do not get any of these payments, Medicare sends you a bill for your Part B premium every 3 months.
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