Medicare Is A Complicated Journey Seniors Need To Travel
Medicare is a complicated journey that many seniors need to travel. You have to know When to enroll in Medicare. You need to see once you enroll in Medicare the medicare limitations Then you need to know whether to enroll in a Medicare supplements plan or a Medicare advantage plan and what is the difference between them. Once you select either a Medicare Supplement plan or a Medicare advantage Plan what does do the plans cover and also understand when to enroll among other things this is why seniors are so confused and need help. Good quality help for a licensed professional that specializes in Medicare.
When Should I First Enroll In Medicare
- When to enroll in Medicare for the first time
- What does Medicare cover and not cover
- Should I enroll in a Medicare Supplement or Medicare Advantage Plan
- What Should I consider when choosing a Medicare Plan
- Can I change my plans if not happy
We generally recommend that people apply for Medicare three months before their 65th birthday. Keep in mind that Medicare benefits cannot begin before age 65. If you are currently receiving Social Security, you will be automatically enrolled in Medicare Part A and B without having to submit an application. You must pay a premium for Part B coverage
If you only want to file for Medicare, call 1-800-772-1213. The Medicare staff can schedule an appointment for you at any convenient Social Security office and will advise you on what to bring with you when applying for Medicare. When applying for Medicare, it’s frequently necessary to submit an application for monthly payments as well.
You can sign up for Medicare Part B during the General Enrollment Period between January 1 and March 31 each year, unless you are eligible for a Special Enrollment Period unless you didn’t join up when you first became eligible for Medicare.
What Does Medicare Cover And What Does Medicare Not Cover
Medicare Part A, often known as hospital insurance, covers the expense of your hospitalization if you are admitted to a hospital, skilled nursing facility, or hospice. It also covers some home health services. When individuals reach age 65 years old, they are usually enrolled in Part A without them having to do anything.
- You will pay a deductible each year with Part A. This is the amount of money you must spend before Medicare kicks in to help. Coinsurance is the portion of hospital care costs that you may be required to cover after fulfilling your deductible.
If you or your spouse receive Social Security payments, there is no cost to enroll in Part A and you will be automatically enrolled.
Part B, also known as medical insurance, covers outpatient treatment. It pays for your doctor’s office visits, tests, and preventive care like cancer screenings and vaccinations.
Part B covers some medical consumables, such as blood sugar test strips, therapeutic shoes, and more. People are frequently enrolled in Part B without even knowing it.
- The premium for Medicare Part B is: A premium that must be paid each month. Your premium may be subject to a penalty if you do not enroll in Part B when you are first eligible.
- A deductible is a fixed sum you pay each year before Part B begins to cover part of your care.
- Some treatments are subject to a cost-sharing limit of 20% of the Medicare-approved amount. These are doctor’s appointments, physical therapy, diabetes supplies, and durable medical equipment like commode chairs and wheelchairs. To receive services, you must first meet your deductible, which is $1,200
If you choose a doctor who has not accepted Medicare-approved charges, you’ll be charged more for a visit and treatment.
Should I Enroll In A Medicare Supplement Plan Or Medicare Advantage Plan
Medicare Supplemental Insurance Plans
Original Medicare, also known as Parts A and B, millions of seniors and disabled Medicare beneficiaries are supplementing their insurance with a Medicare Supplement Insurance Plan. These plans are covered by private insurance plans and you have to pay a premium for them plus they do not cover prescriptions. Medicare Supplement Insurance is not connected with or endorsed by the U.S. government or the federal Medicare program.
While this is certainly the more expensive option, there are a few benefits. Medicare and Medigap insurance plans cover you for any hospital or doctor in the United States that accepts Medicare. The overwhelming majority of hospitals and doctors do accept Medicare, so there’s no need for prior authorization or a referral from a primary care doctor.
Medicare Advantage Plans
Enhanced Medicare plans, also known as Medicare Advantage Plans or other wise known as Medicare Part C, are private health insurance programs that provide additional benefits above and beyond those provided by the federal government through Medicare. Depending on where you reside
Medicare Advantage is a type of insurance offered by the federal government that helps Americans access top-rated medical providers. Medicare Advantage plans are run as health maintenance organizations (HMOs) or preferred provider organizations (PPOs). HMOs, restrict enrollees from accessing providers in their networks. PPOs generally allow consumers to seek care from outside of the Prior authorization is sometimes required for specialized treatment or procedures, as well as a referral from a general practitioner. Care outside of the network’s geographical region may not be covered by insurance. Extra benefits beyond Medicare’s limits, such as eyeglasses, routine dental care, and gym memberships, might be provided. They can either be stand-alone plans, HMO plans, or PPO plans.
Many Medicare Advantage Plans exit, So it is important to determine which plane is best for you. It is important to speak to a qualified professional to determine which plan meets your needs and budget.
What Should I Consider When Choosing A Medicare Plan
Traditional Medicare plus Medigap or Medicare Advantage may work best for you, depending on your life situation, health condition, and financial circumstances. Here are some things to think about:
The Costs Examine whether Medicare Advantage plans save you money. If you want this coverage, you’ll need to acquire a Part D plan if it isn’t included. Check the cost of any premiums, co-pays, and other out-of-pocket expenses to see if there are any restrictions on their coverage. Find out how much of the extra perks will cost you.
Consider these costs in comparison to those of buying Medigap and stand-alone Medicare Part D prescription drug plans. Calculate the premiums, as well as any out-of-pocket expenses (deductibles, copays, coinsurance) that the coverage might entail. Yes, these may be difficult calculations. For most people, this process is to complicate so it is best to seek the counseling of a Medicare Specialist.
Finding the Correct Doctor
You may use any doctor or hospital in the United States that accepts Medicare, and most do. The majority of Medicare Advantage plans restrict you to doctors in their network and may cover less, or not at all, of the costs associated with using out-of-network and out-of-town providers.
A benefit of Medicare Advantage managed care plans is that care is planned, and your primary care physician will be informed about the findings of specialists. You will need a referral to see a specialist or a prior authorization for treatments with traditional Medicare, but you must ensure that treatment is organized and your doctors are in communication with one another. Developing a rapport that is in your best interest.
Your Local Area Providers
In areas where there are few doctors and hospitals, it’s critical to look at both the Medicare Advantage networks and the locations of clinicians who take traditional Medicare. Are any physicians accepting new patients? Will you have to travel far to visit a provider or be treated in an emergency room? Local experts, neighbors, and licensed insurance brokers can assist you in selecting
Local and International Travelers
Frequent mover, or people with two residences, and the need to keep physicians you like are all reasons why traditional Medicare may be a wonderful alternative. Inquire with your present doctors about whether they participate in any Medicare Advantage plans or accept regular Medicare. For frequent fliers, choosing regular Medicare plus a Medigap insurance policy that covers emergency care in other states may be a good bet. Similarly, people who spend part of the year in a different geographical area may find it difficult to stay in-network for medical care and might be better off with regular Medicare and a Medigap insurance policy.
People with Chronic Diseases
Those who have chronic diseases or acquire a severe health issue should research further into their options. A Medicare Advantage plan may be a better option if it has an out-of-pocket maximum that protects you from unaffordable charges. If you’re on traditional Medicare and purchase Medigap insurance, you’ll be able to select where you get your treatment.
Medicare Advantage plans are constantly upgraded altered as the government allows insurers to include benefits that aren’t covered by regular Medicare. These items include paying for lifts for wheelchairs, hold bars, and indoor air quality monitors; adult day care; and residential and in-home respite care, among other things. Many of these services are still being introduced and expanding rapidly.
What If I Am Not Happy With My Plan Can I Switch Back and When Can I Switch
The Annual Election Period runs from October 15 to December 7 each year.
- This is the time when the government allows you to return back to Original Medicare
- Allows you to switch to another Medicare Advantage Plan
The problem is that if you convert back to traditional Medicare (Part A and Part B), you may not be able to purchase a Medigap policy. Medigap insurance companies are usually required to provide coverage to new clients regardless of their health status when they first join up for Medicare Part A and Part B. During their Initial Enrollment Period ( or when they turn 65). However, in subsequent years, they may charge you more for the insurance based on your age and medical conditions.
States have taken action to prevent this. In New York and Connecticut, Medigap insurance policies are guaranteed-issue throughout the year, whereas California, Massachusetts, Maine, Missouri, and Oregon have all established annual windows in which switching is permitted. If you reside in a state without this safeguard, changing systems according to your health condition is dangerous.
As you can see Medicare and choosing a Medicare Insurance Plan can Make it complex, convoluted, and our right confusing. At YourMedicare by AYA and Associates, we make this process clear, simple, and understandable. Please contact us at 1-800-381-3623 or visit our website
and we will be happy to help you.