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Medicare

 

    1. Premium: The amount you pay each month to be enrolled in Medicare or a Medicare plan. It’s like a subscription fee for your healthcare coverage.

    2. Deductible: The amount you must pay out of pocket for healthcare services before Medicare starts to pay. Once you reach the deductible, Medicare will contribute its share towards the cost of your care.

    3. Copayment: A fixed amount you pay for a healthcare service or prescription medication. For example, you might have a copayment of $20 for each doctor’s visit or a copayment of $10 for each prescription.

    4. Coinsurance: The percentage of the cost of a healthcare service that you’re responsible for paying after reaching your deductible. For instance, if your coinsurance is 20%, you would pay 20% of the total cost, and Medicare would cover the remaining 80%.

    5. Out-of-Pocket Maximum: The maximum amount you will have to pay for covered services in a calendar year. Once you reach this limit, Medicare will cover 100% of your healthcare costs for the rest of the year.

    6. Original Medicare: The traditional fee-for-service Medicare program offered directly by the federal government. It includes Medicare Part A (hospital insurance) and Part B (medical insurance).

    7. Medicare Advantage (Part C): Private insurance plans approved by Medicare that offer an alternative way to receive Medicare benefits. These plans often include additional benefits and may have provider networks.

    8. Medicare Part D: Prescription drug coverage offered through private insurance companies approved by Medicare. Part D helps pay for the cost of prescription medications.

    9. Medigap: Medicare Supplement Insurance plans sold by private insurance companies to help cover some of the costs that Original Medicare doesn’t pay, such as deductibles, copayments, and coinsurance.

    10. Initial Enrollment Period (IEP): The seven-month period surrounding your 65th birthday when you are first eligible to enroll in Medicare. This is the best time to sign up to avoid potential late enrollment penalties.

    11. Special Enrollment Period (SEP): A period outside the initial enrollment period when you can sign up for Medicare due to certain life events, such as losing employer coverage or moving to a new area.

    12. Formulary: A list of prescription drugs covered by a Medicare Part D plan. Each plan has its own formulary, so it’s important to check if your medications are covered before choosing a plan.

    13. Network: The group of doctors, hospitals, and other healthcare providers that have contracted with a specific Medicare Advantage plan or private insurance company to provide services to plan members.

    14. Prior Authorization: The process of getting approval from Medicare or your insurance company before receiving certain healthcare services, medications, or procedures. It ensures that the treatment is medically necessary.

    15. Annual Wellness Visit: A yearly appointment with your healthcare provider to create or update a personalized prevention plan based on your current health and risk factors. This visit is covered by Medicare at no cost to you.

Q: What is Medicare? A: Medicare is a health insurance program provided by the government for people who are 65 or older, certain younger individuals with disabilities, and those with end-stage renal disease.

Q: How is Medicare different from Medicaid? A: While both Medicare and Medicaid are government programs that assist with healthcare costs, Medicare primarily serves older adults and people with disabilities, regardless of income. Medicaid, on the other hand, is based on financial need and provides health coverage to low-income individuals and families.

Q: What are the different parts of Medicare? A: Medicare is divided into several parts:

  • Part A: Hospital insurance that helps cover inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.
  • Part B: Medical insurance that helps cover doctor visits, outpatient care, preventive services, and medical supplies.
  • Part C: Also known as Medicare Advantage, it offers an alternative way to receive Medicare benefits through private insurance companies.
  • Part D: Prescription drug coverage that helps pay for prescription medications.

Q: When should I enroll in Medicare? A: If you’re already receiving Social Security benefits, you’ll be automatically enrolled in Medicare Parts A and B when you turn 65. If you’re not receiving Social Security benefits, you’ll need to proactively sign up during the Initial Enrollment Period (IEP), which begins three months before your 65th birthday and lasts for seven months.

Q: Do I need to pay for Medicare? A: While most people do not pay a premium for Medicare Part A (if they have paid Medicare taxes while working), there are premiums associated with Medicare Part B and Part D. The amount you pay depends on your income and the plan you choose.

Q: Can I have other insurance along with Medicare? A: Yes, it’s possible to have other insurance alongside Medicare. Many people choose to get additional coverage through a Medicare Supplement Insurance (Medigap) policy to help pay for costs that Medicare doesn’t cover. Others opt for Medicare Advantage plans that provide both Medicare Parts A and B coverage, often with prescription drug coverage as well.

Q: What does Medicare not cover? A: Medicare doesn’t cover everything, and there are gaps in coverage. Some examples of services not covered by Medicare include long-term care, most dental care, eye exams for glasses, hearing aids, and cosmetic surgery.

Q: Can I change my Medicare coverage? A: Yes, there are specific periods when you can change your Medicare coverage. The Annual Enrollment Period (AEP) occurs each year from October 15 to December 7, during which you can switch between Medicare Advantage and Original Medicare, change or add a Part D plan, or move from one Part D plan to another.

Q: How do I find doctors who accept Medicare? A: You can find doctors who accept Medicare by using the “Physician Compare” tool on the official Medicare website or by contacting the doctor’s office directly and asking if they accept Medicare patients.

Q: What if I need help understanding Medicare or making decisions? A: If you need assistance understanding Medicare or making decisions about your coverage, you can contact your State Health Insurance Assistance Program (SHIP) or speak with a licensed insurance agent who specializes in Medicare.