What You Need To Know About Medicare

Medicare may seem confusing, but if you take it step by step, it all becomes clear. Start with Medicare Part A. This helps cover inpatient care in hospitals, skilled nursing facility care, hospice care and home health care.

Next, you have Part B, which covers services from doctors and other health care providers, as well as:

  • Outpatient care.
  • Home health care.
  • Durable medical equipment such as wheelchairs, walkers and hospital beds.
  • Preventive services — screenings, shots or vaccines and yearly wellness visits.

Part B will cover most routine medical expenses as well as emergency room and urgent care services.

Medicare Advantage plans are Part C. Medicare Advantage is a Medicare-approved plan from a private company that bundles Parts A, B and typically D, which helps cover the cost of prescription drugs.

With Medicare Advantage, you’ll need to use doctors who are in the plan’s network. Medicare Advantage plans may have lower out-of-pocket costs than Original Medicare does. In addition, they may offer some extra benefits, such as vision, hearing and dental services.

You join a Medicare drug plan in addition to Original Medicare or you get it by joining a Medicare Advantage plan with drug coverage. Medicare drug coverage is run by private insurance companies that follow rules set by Medicare.

If you stick with Original Medicare, this just includes Part A and Part B. You can use any doctor or hospital that takes Medicare anywhere in the U.S.

What should you do?

You only need to sign up for Part A and Part B once. Each year, you can choose how you want to get your health care coverage and whether you want to add or switch drug coverage. You don’t have to make the same choice as your spouse — Medicare plans aren’t offered for couples or families.

There’s also Medicare Supplement Insurance that’s called Medigap, a policy to help lower your share of costs for services you get. Medigap policies are run by private companies to fill the holes in regular Medicare coverage — copayments, deductibles and health care coverage — when you travel outside the country.

If you are receiving medical coverage through your job, you’re not required to enroll in Part B, but you may have to pay a late enrollment fee — in the form of a higher premium — when you finally do sign up for Part B. Late enrollment rules can be complex, but the government explains them in more detail online.

How does Medicare Advantage work?

You join through Medicare-approved private companies. Some Medicare Advantage plans will ask you to get referrals to see a specialist and others offer additional benefits to treat specific conditions.

With Medicare Advantage, you pay a premium for the plan in addition to the monthly Part B premium. Plans may have a $0 premium or may help pay all or part of your Part B premium. You can’t buy or use separate supplemental coverage like Medigap with Medicare Advantage.

If you or your spouse has worked and paid Medicare taxes for at least 10 years, Part A of Medicare is free. Part A and Part B each have annual deductibles you must reach before Medicare starts paying. Part C and Part D have monthly premiums that vary based on the plan you choose.

Basically, Medicare is a way for people to have health care coverage as they get older and leave the workforce. The program is funded primarily by three sources: general revenues, payroll taxes and beneficiary premiums.

Of course, this is just a summary, and there will be additional provisions and exceptions. What’s right for you? It depends on your particular financial and family situation. Work with a financial professional to find the options best suited for you.

For more information, please visit our website at www.benefitsbydesignca.com

Contact us at Benefits by Design Insurance Services at 760-696-3573 for Medicare quotes. We offer all health insurance companies in California. Let us help you to simplify the Getting Ready for Medicare process for you.