Medicare Frequently Asked Questions

Wed, Oct 28, 2020 5:52 PM Medicare

You may have any concerns if you or a loved one has just signed up for Medicare or is hoping to sign up soon. Those issues may include: What's covered by Medicare? What Medicare coverage is going to cover my prescription medication? How much would it be for my monthly Medicare expenses?

In this article, to help address some of those often asked questions about Medicare, we will discuss topics such as availability, cost, and more.
 

When am I eligible to participate in Medicare?

Americans who are 65 and older are fully eligible for Medicare enrollment. Also, qualifying is those people under the age of 65 who have long-term disabilities. Here's how qualifying for Medicare works:

• You are entitled to enroll in Medicare 3 months before your 65th birthday and up to 3 months after if you reach 65 years old.
• After 24 months, you are eligible for Medicare if you receive monthly disability payments from either the Social Security Administration or the Railroad Retirement Board.
• You are eligible for Medicare automatically if you have amyotrophic lateral sclerosis (ALS) and receive monthly disability benefits.
• You are entitled to participate in Medicare if you have been diagnosed with end-stage renal disease and have had a kidney transplant or need dialysis.

Are Medicare prescription drugs covered?

Some drugs are protected by Original Medicare. For instance:

• Part A of Medicare includes drugs used while you are in the hospital for your treatment. Some drugs used in home health or hospice care are also provided.
• Part B of Medicare includes some drugs given in outpatient environments, such as in the office of a doctor. Part B includes vaccination as well.

You must participate in either Medicare Part D or a Medicare Part C plan that has drug coverage to get full Medicare prescription drug coverage.

Medicare Part D

To help offset the cost of your prescription medications, you can add Medicare Part D to the Original Medicare. A form is given for each Part D plan, which is a list of the prescription medications it will cover. These prescription drugs, mostly classified by price and brand, fall into particular levels. In the main drug groups, all Medicare Part D programs would include at least two medications.

Medicare Part C

Prescription drug coverage is also provided by most Medicare Advantage plans. Each Advantage plan will have its own form and coverage rules, as will Medicare Part D. Only bear in mind that if you use out-of-network drugstores, certain Medicare Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) plans can charge more for your prescriptions.

What is covered by Medicare?

Medicare comprises Part A, Part B, Part C (Advantage), Part D, and Medigap, both of which provide coverage for your fundamental medical needs.

Original Medicare

Part A and Part B of Medicare are collectively referred to as initial Medicare. Original Medicare includes only your hospital needs and those that are medically required or preventive, as you can understand. It does not cover prescription medications, regular dental or vision screenings, or other medical care related expenses.

Medicare Part A

Part A covers the following hospital services:

1. skilled nursing facility care
2. nursing home care (not long term)
3. home health care
4. hospice care
5. inpatient hospital care
6. inpatient rehabilitation care

Medicare Part B

Part B covers medical services including:

1. mental health services
2. certain outpatient prescription drugs
3. telehealth services (as part of the current response to the COVID-19 outbreak)
4. preventive medical care
5. diagnostic medical care
6. treatment of medical conditions
7. durable medical equipment

Medicare Part C  (Medicare Advantage)

Medicare Advantage is provided by private insurance providers as a Medicare alternative. Initial Medicare Part A and B programs are provided by these arrangements. Some also provide prescription medicine coverage; dental, vision, and hearing services; wellness services; and more.

Medicare Part D 

Part D of Medicare helps cover prescription drug costs. Medicare Part D policies are sold and can be added to the original Medicare by private insurance providers. What will it Cost You When you Join Medicare?

Medicare Supplement (Medigap)

Medigap programs help offset the original Medicare-related expenses. This can include deductibles, copayments, and co-insurance. Some Medigap policies also help pay for medical expenses that you can incur while traveling outside the country.

How much does it cost Medicare?

There are costs associated with each Medicare part that you participate in, including premiums, deductibles, copayments, and coinsurance. 

Is Medicare free?

Some plans for Medicare Advantage are marketed as "free" plans. Although these plans can be premium-free, they are not fully free: certain out-of-pocket expenses may also have to be charged by you.

What's the deductible for Medicare?

The amount of cash you pay out of pocket per year (or period) for your services before Medicare coverage kicks in is a Medicare deductible. Parts A, B, C, and D in Medicare all have deductibles.

What is a Medicare copay?

The sum you have to pay out of pocket each time you receive treatment or refill a prescription medication is a Medicare copayment or copay.

Medicare Advantage (Part C) programs charge varying sums for appointments by physicians and specialists. For out-of-network services, such plans charge higher copayments.

Medicare drug programs bill, depending on the plan type, varying copayments for medications.

What is Medicare coinsurance?

The amount that you pay out of pocket for the expense of your Medicare-approved programs is Medicare coinsurance.

The longer you are hospitalized, Medicare Part A charges a higher coinsurance fee. A determined coinsurance amount of 20 percent is paid by Medicare Part B.

Medicare Part D policies bill coinsurance rates the same as copayments, and your prescription medications can only ever bill one of the two, not both.

When I'm outside of my state, can I use Medicare?

Original Medicare provides all beneficiaries national coverage. This ensures that out-of-state medical insurance is provided for you.

Medicare Advantage plans, on the other hand, only have coverage for the state in which you live, although some can provide out-of-state in-network services as well.

You should always ensure that the provider you visit supports the Medicare assignment, whether you have original Medicare or Medicare Advantage.

What is Medicare Premium?

The monthly fee you pay to be enrolled in a Medicare plan is a Medicare premium. Monthly premiums are all paid for Part A, Part B, Part C, Part D, and Medigap.

What's the out-of-pocket limit for Medicare?

The cap on how much you can pay out of pocket for all your Medicare expenses in a single year is a Medicare out-of-pocket maximum. In initial Medicare, there is no cap on out-of-pocket costs.

There is an estimated out-of-pocket limit amount for all Medicare Advantage programs, which varies according to the plan you are participating in. Enrolling in a Medigap plan will also help reduce out-of-pocket annual expenses.

 

Final thoughts

It may feel a little difficult to grasp Medicare, but there are many tools at your disposal. Here are some additional tools that can help if you need extra help signing up for Medicare or still have unanswered questions:

• CMS.gov provides up-to-date information about the Medicare program's official policy reforms and updates.
• You can use your Medicare account and more services for Social Security and Medicare through SSA.gov.
• Medicare.gov has local provider details, vital forms, useful booklets to download, and more.

 

 

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