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Frequently Asked Questions

What are the different parts of Medicare, and what do they cover?

  • Part A (Hospital Insurance): Covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

  • Part B (Medical Insurance): Covers certain doctors' services, outpatient care, medical supplies, and preventive services.

  • Part C (Medicare Advantage): An alternative to Original Medicare that offers all Part A and Part B coverage and sometimes includes additional benefits like dental, vision, and prescription drugs.

  • Part D (Prescription Drug Coverage): Adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service plans, and Medicare Medical Savings Account Plans.

How do I know if I am eligible for Medicare, and when can I enroll?

Individuals are eligible for Medicare if they are 65 or older, younger than 65 with certain disabilities, or any age with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant).

There are specific enrollment periods, such as the Initial Enrollment Period (IEP) around their 65th birthday, the General Enrollment Period (GEP) from January 1 to March 31 each year, and the Special Enrollment Period (SEP) under certain conditions like losing employer coverage.

What is the difference between Original Medicare and Medicare Advantage?

Original Medicare includes Part A and Part B. Patients can see any doctor or hospital that accepts Medicare in the U.S. Medicare Advantage (Part C) plans are offered by private companies approved by Medicare and may have network restrictions, meaning you must see doctors and hospitals within the plan’s network. These plans often include extra benefits like dental, hearing, and vision care.

Do I need additional coverage beyond Original Medicare?

Many people choose to buy additional coverage, such as a Medicare Supplement Insurance (Medigap) policy to help pay some of the remaining health care costs like copayments, coinsurance, and deductibles. Another option is Part D for prescription drugs if not included in their Medicare Advantage plan.

How much does Medicare cost?

The cost of Medicare varies. Part A is usually premium-free if you or your spouse paid Medicare taxes for a certain amount of time. Part B has a standard monthly premium, which could be higher based on your income. Medicare Advantage and Part D plans have varying premiums depending on the plan chosen. There are also deductibles and copays to consider.

What does Medicare not cover?

Medicare does not cover everything. Items and services generally not covered include long-term care, routine dental or eye care, dentures, cosmetic surgery, acupuncture, hearing aids, and exams for fitting them. It’s important to know these gaps to plan for additional coverage if needed.

Can I change my coverage if my needs change?

Yes, during the Annual Election Period (October 15 to December 7 each year), you can make changes to various aspects of your coverage, including switching from Original Medicare to Medicare Advantage or vice versa, switching between Medicare Advantage plans, or adding/dropping Part D coverage.