What is Medicare? According to Wikipedia, “Medicare is a national health insurance program in the United States, begun in 1966 under the Social Security Administration and now administered by the Centers for Medicare and Medicaid Services. It provides health insurance for Americans aged 65 and older. It also provides health insurance to younger people with some disability status as determined by the Social Security Administration, as well as people with end-stage renal disease and amyotrophic lateral sclerosis.” In her article “Getting Ready to Enroll in Medicare?” Dina Bunis states that “more than 60 million Americans get their health care coverage through this federal insurance program for older Americans.” At 65, you automatically become eligible for the program. However, helping your loved one apply for Medicare for the first time can seem like an overwhelmingly daunting task, but it does not need to be. Many useful online resources can help make this task seem effortless and easy. Here are some things you can do to help your loved one apply for Medicare for the first time.
Age for Medicare eligibility
Even though everyone is automatically eligible for Medicare when they become 65, there is no notice you will receive in the mail. You must take the first steps to enroll yourself or your loved one into the program. According to Dena Bunis, “The timetable is specific and important. You can start signing up three months before you turn 65 and you’ll have until three months after your birthday month to enroll.” If you miss this deadline, you may end up paying higher premiums!
Medicare options and plans
Within Medicare, there are several options and plans available. When you first enroll in Medicare and during certain times of the year, you can choose how you get your Medicare coverage. You will want to pick the options that your loved one can afford and that will meet your loved one’s particular medical needs. The article “Getting Ready to Enroll in Medicare?” lists the four essential parts of Medicare. These will cover your loved one for everything from doctor visits to prescription drugs to hospital care.
- Part A – Hospital Insurance. This includes hospital care and some nursing home, rehabilitation, and hospice care.
- Part B – Medical Insurance. This covers doctor visits, lab tests, screenings, and other outpatient services.
- Part C – Both Hospital and Medical Insurance. This is also called Medicare Advantage. It is comprehensive coverage that combines Parts A and B and is provided by private insurers, usually through HMO or PPO plans.
- Part D covers prescription drugs.
So basically, there is Original Medicare and Medicare Advantage. Original Medicare is more ala carte while Medicare Advantage is a bundle package of Parts A and B and most likely D. Your first decision for your loved one is which of these two options best fits his or her needs. They both have their pros and cons.
Pros and cons of original Medicare
The pros of enrolling in Original Medicare are as follows:
- You can choose any provider that participates in the program.
- You won’t need referrals to see specialists.
- You will be covered throughout the United States.
- Premiums are set by the Federal Government.
The cons of enrolling in Original Medicare are as follows:
- It does not cover everything.
- If you have serious medical conditions, your out-of-pocket costs could be high since there is no cap on such expenses.
- You have to sign up separately for prescription drug coverage (Part D).
- You have to sign up separately for private supplemental (or Medigap) insurance to help cover your out-of-pocket costs, such as hospital deductibles.
According to Medicare.gov, “Generally, you pay a deductible and coinsurance for your Part A and Part B services.” The coverage is provided by Medicare.
Pros and cons of Medicare Advantage plans
The pros of enrolling in Medicare Advantage (MA) are as follows:
- You will be enrolled in a private insurance alternative to Original Medicare.
- These plans provide one-stop coverage.
- Many offer dental, vision, and hearing benefits.
- These plans typically have lower out-of-pocket costs than Original Medicare.
- These plans have an annual cap on out-of-pocket expenses. Once you reach a certain limit, you’ll pay nothing for covered services for the rest of the year.
The cons of enrolling in Medicare Advantage are as follows:
- You may need referrals to specialists.
- You may pay more to see providers who are not part of the plan’s network.
- Your access to coverage beyond where you live could be limited.
According to Medicare.gov, “You usually pay a monthly premium for your MA plan (in addition to your monthly Part B premium).” You may also pay a copayment or coinsurance for covered services. The coverage is provided by private insurance companies approved by Medicare.
Prescription drug coverage
Once you have decided which option you are going with (Original Medicare or Medicare Advantage), you need to determine if you want prescription drug coverage. If you decided to choose Original Medicare and wish to have prescription drug coverage, you will need to select and join a Medicare Prescription Drug Plan. These usually have a monthly premium. If you chose Medicare Advantage and you want prescription drug coverage, you must get the coverage through your MA plan.
Finally, once you have selected your plan and decided on prescription drug coverage, you will need to determine if you want supplemental coverage. This coverage is called Medicare Supplemental Insurance or Medigap. If you decided on Original Medicare, choosing Medigap will help cover some health care costs that Original Medicare does not cover like copayments, coinsurance, and deductibles. If you decided on Medicare Advantage, you cannot buy or use separate supplemental coverage.
More for you:
- What Benefits does Medicare Provide for Alzheimer’s Patients?
- Five basic tips for caregivers to navigate Medicare for persons in their care
- Medicare Resources | Social Security Resource Center. https://socialsecurityofficenear.me/topics/medicare/
- Medicare Made Easy: Your Enrollment Guide – aarp.org. https://www.aarp.org/health/medicare-insurance/info-2018/medicare-made-easy.html
- Your Medicare coverage choices | Medicare. https://www.medicare.gov/what-medicare-covers/your-medicare-coverage-choices