10 Common Medicare Questions About Coverage Answered

Shelia Benson

It’s that time of year again! The Medicare Open Enrollment period is here and runs through December 7th.

Enrolling in Medicare can be quite a challenge and a new process for some. Understanding the different parts of Medicare can be confusing.

In this article, we’ll review a list of ten common questions related to Medicare coverage so that you can feel prepared to enroll when the time comes


Commonly Asked Medicare Coverage Questions

1. How do I know which Medicare benefits are right for me?

Some questions to ask yourself are “How many times will I be going to the Doctor in a year?”, “What prescription drugs will I need?”, “Do I want to keep my same Providers?”.

These questions are helpful when it comes to selecting the right Medicare plan for you. If you see a particular specialist or need intensive medical care you may want to enroll in the richest plan to ensure you are receiving the benefits you need.

You will also want to make sure that your provider is covered in-network before choosing a plan to ensure you will not have any expensive co-pays.

Additionally, take into consideration the costs of your prescription drugs.


2. How much does Medicare cost?

You will likely pay a monthly premium for Medicare Part B, as well as other Medicare premiums, deductibles, copays, and coinsurance. The amount you pay for medical coverage will be determined by the plan that you choose to enroll in.

For more information on the premium amounts please refer to www.medicare.gov.

 

3. What happens if I am still working past age 65?

If you work past age 65, you may be able to delay enrolling in Medicare or you have the option of enrolling during your Initial Enrollment Period in Parts A, B, and D if you want to avoid late penalties. This will depend on your employer and if your employer coverage is creditable.

Refer to your employer's Human Resources department to find out what you need to do about Medicare when still working. Some people choose to still enroll in just Part A while still employed.

Part A coverage is premium free, as long as you or your spouse worked and paid Medicare taxes for at least 10 years.

 

4. What does Medicare Part A cover?

Medicare Part A or “hospital insurance” covers inpatient care in a hospital, skilled nursing facility, nursing home care, hospice care, and home health care.

Medicare Part A premiums are usually free, as long as you paid Medicare taxes for at least 10 years. These plans are considered “Original Medicare” alongside your Medicare Part B plan.

 

5. What does Medicare Part B cover?

Medicare Part B covers services or supplies needed to diagnose or treat your medical condition as well as necessary medical equipment. It also provides preventive services such as diabetes screenings, depression screenings, flu shots, and your yearly wellness check-up.

Think of Medicare Part B as your traditional health insurance plan that covers medical services and routine exams. 

 

6. What is Medicare Part C?

Medicare Part C or “Medicare Advantage” is another Medicare health plan coverage you can enroll in. Medicare Advantage plans are offered through private insurance companies. 

Each Medicare Advantage Plan has a different charge for out-of-pocket costs and has different rules for how you can receive services. This includes whether or not you need a referral to see a specialist or if you have to go to only health care providers and facilities or use suppliers that belong to the plan for non-emergency or non-urgent care services. 

Note: Medicare Advantage rules can change each year, refer to your plan benefit guide for specifics.

 

7. Do I need to sign up for a Medicare Part D Prescription Drug plan?

Enrolling in a Medicare Part D plan is voluntary, however, if you take specific medications you may want to enroll in coverage.

Keep in mind, Prescription Drug coverage is not included in Medicare supplement insurance. It’s important to evaluate your choices before enrolling in coverage, sometimes the “best” and most expensive plan offers little or no extra value.

 Prescription Drug Plans can be purchased through private insurance companies. If you are unable to pay Medicare Part D premiums but take specific prescription drugs you may be able to qualify for extra help. Contact your local Social Security Administration office for further detail.

 

8. When will my benefits be effective?

If you are enrolling during your Initial Enrollment Period, your enrollment period lasts for seven months, starting three months before your turn age 65, and ending three months after you turn age 65.

Unsure of when your Medicare plan will go into effect? Refer to the list below: 

  • Enrolling the month before you turn 65:

    •  Your coverage will begin the month you turn 65 years old.

    • The month you turn 65:

      •  Your coverage will begin the following month.

    • 1 month after you turn 65 In 2022: 

      • 2 months after you sign up

      • Starting January 1, 2023: the next month

  • 2 or 3 months after you turn 65: 

    • In 2022: 3 months after you sign up

    • Starting January 1, 2023: the next month


9. What happens if I move out of the area, will I lose my Medicare benefits?

No, this would be considered a “Special Enrollment Period” where you can make changes to your Medicare Advantage or Medicare Prescription drug plan. 

There are certain events that would qualify you to make changes, such as moving out of the area, you lose current coverage, or having the opportunity to get other coverage.

 

10. Are there programs available to help pay for Medicare premiums?

There are several programs for people that are considered low-income. If you have a low income you may be able to get assistance through the following programs:

  • Medicaid: If you have a low monthly income and assets, you may be eligible for coverage through Medicaid to pay for your Medicare costs, such as copays, deductibles, and health care services not covered by Medicare, such as dental and transportation to doctor's appointments.

    • Medicare Savings Programs (MSPs): If you do not qualify for Medicaid but still struggle to pay for health care, you may qualify for an MSP plan which is a government-run program that helps cover your Medicare Costs. There are three types of Medicare Savings Programs that help pay the monthly Medicare Part B premium.

    • Extra Help or Part D Low-Income Subsidy (LIS): This is a federal program that helps pay for some costs of Medicare Part D prescription drug costs.

    • State Health Insurance Assistance Program: These plans are offered in some states to help eligible individuals pay for prescriptions. 

Note: These plans have income guidelines and may also require you to enroll in a Medicare Part D plan and apply for Extra Help.

Many Medicare beneficiaries make the simple mistake of enrolling in the wrong medical plan due to not being knowledgeable about the various Medicare parts and Medicare rules. It is very important to do research on Medicare plans prior to signing up or making any changes.

Any enrollments or changes made will take effect on January 1, 2023, and you will have to wait til the following year to make any changes to your medical insurance. 

Additionally, you may want to make sure you are enrolling in the correct plans that are in compliance with Medicare guidelines to prevent any late enrollment penalties. If you have any particular questions regarding Medicare eligibility and Medicare enrollment visit the Medicare website for additional answers to questions you may have.

Visit www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227) TTY users can call 1-877-486-2048.