Collection: Medicare FAQ

Medicare FAQ: The 50 Most Common Questions and Answers

1. What is Medicare?
   • Answer: Medicare is a federal health insurance program primarily for individuals aged 65 and older, but it also covers some younger people with disabilities and those with End-Stage Renal Disease (ESRD).
2. Who is eligible for Medicare?
   • Answer: People aged 65 or older, younger people with disabilities, and individuals with ESRD or ALS.
3. How do I enroll in Medicare?
   • Answer: You can enroll during your Initial Enrollment Period (IEP), which begins three months before you turn 65, includes the month you turn 65, and ends three months after your 65th birthday.
4. What are the different parts of Medicare?
   • Answer: Medicare has four parts: Part A (Hospital Insurance), Part B (Medical Insurance), Part C (Medicare Advantage), and Part D (Prescription Drug Coverage).
5. Is Medicare free?
   • Answer: Part A is usually premium-free if you or your spouse paid Medicare taxes while working. Part B, Part C, and Part D require premiums.

Medicare Part A

6. What does Medicare Part A cover?
   • Answer: Part A covers inpatient hospital care, skilled nursing facility care, hospice care, and some home health care.
7. Do I have to pay a premium for Medicare Part A?
   • Answer: Most people don't pay a premium for Part A if they or their spouse have paid Medicare taxes for at least 10 years.
8. What is the deductible for Medicare Part A?
   • Answer: The deductible for inpatient hospital stays in 2024 is $1,600 per benefit period.
9. How long does Medicare Part A cover hospital stays?
   • Answer: Part A covers up to 60 days in a hospital without co-insurance, 61-90 days with co-insurance, and 91+ days using lifetime reserve days.
10. What are lifetime reserve days in Medicare Part A?
    • Answer: These are additional days that Medicare will pay for when you are in a hospital for more than 90 days. You have 60 reserve days that can be used once in your lifetime.

Medicare Part B

11. What does Medicare Part B cover?
    • Answer: Part B covers outpatient care, doctor services, preventive services, and durable medical equipment.
12. What is the premium for Medicare Part B?
    • Answer: The standard monthly premium for Part B in 2024 is $174.70, but it can be higher based on your income.
13. What is the deductible for Medicare Part B?
    • Answer: The annual deductible for Part B in 2024 is $240.
14. Does Medicare Part B cover preventive services?
    • Answer: Yes, Part B covers many preventive services like flu shots, screenings for cancer, diabetes, and cardiovascular disease, as well as annual wellness visits.
15. What is the coinsurance for Medicare Part B?
    • Answer: After meeting the deductible, you typically pay 20% of the Medicare-approved amount for most doctor services, outpatient therapy, and durable medical equipment.

Medicare Part C (Medicare Advantage)

16. What is Medicare Advantage (Part C)?
    • Answer: Medicare Advantage plans are an alternative to Original Medicare offered by private insurance companies approved by Medicare. They provide all Part A and Part B benefits and often include Part D and extra benefits.
17. How do Medicare Advantage plans differ from Original Medicare?
    • Answer: Medicare Advantage plans often have networks of doctors and hospitals and may offer additional benefits such as dental, vision, and wellness programs.
18. What are the costs associated with Medicare Advantage plans?
    • Answer: Costs vary by plan and can include premiums, deductibles, copayments, and coinsurance. Some plans have a $0 premium but still have other costs.
19. Can I switch from Original Medicare to a Medicare Advantage plan?
    • Answer: Yes, you can switch during the Medicare Open Enrollment Period from October 15 to December 7 each year.
20. What is the Medicare Advantage Open Enrollment Period?
    • Answer: From January 1 to March 31 each year, individuals with Medicare Advantage plans can switch to another Medicare Advantage plan or return to Original Medicare.

Medicare Part D (Prescription Drug Coverage)

21. What is Medicare Part D?
    • Answer: Part D is prescription drug coverage offered by private insurance companies approved by Medicare.
22. Is Medicare Part D mandatory?
    • Answer: No, but if you don't have credible prescription drug coverage and delay enrollment, you may face a late enrollment penalty.
23. How much does Medicare Part D cost?
    • Answer: Costs vary by plan and include monthly premiums, annual deductibles, and co-payments or coinsurance.
24. What is the "Donut Hole" in Medicare Part D?
    • Answer: The "Donut Hole" is a coverage gap during which you pay a higher share of prescription drug costs until you reach the catastrophic coverage threshold.
25. When can I enroll in a Medicare Part D plan?
    • Answer: You can enroll during your Initial Enrollment Period, the Medicare Open Enrollment Period, or during a Special Enrollment Period if you qualify.

Medicare Supplement Insurance (Medigap)

26. What is Medigap?
    • Answer: Medigap is supplemental insurance sold by private companies that helps pay some of the out-of-pocket costs not covered by Original Medicare, such as copayments, coinsurance, and deductibles.
27. When can I buy a Medigap policy?
    • Answer: The best time to buy a Medigap policy is during your Medigap Open Enrollment Period, which starts the first month you have Medicare Part B and are 65 or older. During this period, you have a guaranteed issue right.
28. What are the different types of Medigap plans?
    • Answer: There are 10 standardized Medigap plans in most states, labeled A through N, each offering a different level of coverage.
29. Can I have both a Medicare Advantage plan and a Medigap policy?
    • Answer: No, it is illegal for anyone to sell you a Medigap policy if you have a Medicare Advantage plan.
30. How much do Medigap policies cost?
    • Answer: Costs vary by plan, location, and insurer. Premiums generally range from around $50 to several hundred dollars per month.

Enrollment and Eligibility

31. What is the Initial Enrollment Period (IEP)?
    • Answer: The IEP is the 7-month period that begins three months before you turn 65, includes your birthday month, and ends three months after your birthday month.
32. What is the General Enrollment Period (GEP)?
    • Answer: The GEP runs from January 1 to March 31 each year. If you missed your IEP, you can sign up for Part A and/or Part B during this period, with coverage starting on July 1.
33. What is a Special Enrollment Period (SEP)?
    • Answer: SEPs allow you to enroll in Medicare outside of the regular enrollment periods due to specific life events, such as losing employer coverage.
34. What happens if I miss my Initial Enrollment Period?
    • Answer: If you miss your IEP and don't qualify for an SEP, you may have to wait until the GEP to enroll and could face late enrollment penalties.
35. Can I delay Medicare enrollment if I am still working?
    • Answer: Yes, if you have employer coverage, you can delay enrolling in Part B without penalty. You’ll get an SEP to sign up for Part B when your employment ends.

Costs and Payments

36. What are Medicare premiums?
    • Answer: Premiums are the monthly payments you make to have Medicare coverage. Part B and Part D require premiums, and some people may pay premiums for Part A.
37. What is the Income-Related Monthly Adjustment Amount (IRMAA)?
    • Answer: IRMAA is an extra charge added to your Part B and Part D premiums if your income is above a certain threshold.
38. How are Medicare costs determined?
    • Answer: Medicare costs depend on your income, the type of coverage you choose, and the services you use.
39. What is the Medicare Savings Program?
    • Answer: This program helps people with limited income and resources pay for some or all of their Medicare premiums, deductibles, co-payments, and coinsurance.
40. Can I get help paying for my Medicare Part D costs?
    • Answer: Yes, the Extra Help program assists with Part D costs for people with limited income and resources.

Coverage and Benefits

41. Does Medicare cover dental care?
    • Answer: Medicare does not cover routine dental care, dentures, or most dental procedures. Some Medicare Advantage plans offer dental benefits.
42. Does Medicare cover vision care?
    • Answer: Original Medicare does not cover routine eye exams, glasses, or contacts. Some Medicare Advantage plans offer vision benefits.
43. Does Medicare cover hearing aids?
    • Answer: Original Medicare does not cover hearing aids or exams for fitting them. Some Medicare Advantage plans offer hearing benefits.
44. What preventive services does Medicare cover?
    • Answer: Medicare covers many preventive services, including screenings, vaccines, and annual wellness visits, usually at no cost to you.
45. Does Medicare cover long-term care?
    • Answer: Medicare does not cover long-term care (custodial care) in a nursing home. It only covers medically necessary skilled nursing care for a limited time.

Additional Information

46. What is a Medicare Summary Notice (MSN)?
    • Answer: An MSN is a notice you receive every three months if you have Original Medicare. It lists the services you received and the amount Medicare paid.
47. How do I appeal a Medicare decision?
    • Answer: If you disagree with a coverage or payment decision, you can file an appeal. The steps and deadlines for appeals are listed on your MSN.
48. What is Medicare fraud?
    • Answer: Medicare fraud involves intentionally billing Medicare for services or supplies you didn't receive or overcharging for services. Report fraud to Medicare.
49. What is a Medicare Advantage Plan Annual Notice of Change (ANOC)?
    • Answer: The ANOC is a notice you receive each year in the fall from your Medicare Advantage plan, detailing any changes in coverage, costs, or service areas for the upcoming year.
50. Where can I get more information about Medicare?
    • Answer: You can visit the official Medicare website at www.medicare.gov, call 1-800-MEDICARE, or consult with a SHIP (State Health Insurance Assistance Program) counselor for personalized help.
    • You can also contact Plain Talk Advisors & work with one advisor that can answer any/all questions you have 901.301.2414 email Joey@plaintalkadvisors.com

Conclusion

Understanding Medicare and its various components can seem overwhelming, but it’s essential for making informed healthcare decisions. Whether you’re approaching Medicare eligibility or assisting a loved one, this FAQ serves as a valuable resource. Remember, working with a knowledgeable professional can simplify the process and help ensure you receive the benefits you deserve