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What is Medicare?

Medicare is the federal health insurance program for people over 65.

Who is Medicare for?

People who are 65 or older Certain younger people with disabilities People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD) The different parts of Medicare help cover specific services:

What does Medicare cover?

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

Medicare Part B (Medical Insurance)
Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services.

Medicare Part D (prescription drug coverage) Part D adds prescription drug coverage to:

  • Original Medicare
  • Some Medicare Cost Plans
  • Some Medicare Private-Fee-for-Service Plans
  • Medicare Medical Savings Account Plans

These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.

I’m still working. Do I need to sign up?

That depends on the size of your company. If you or your spouse (if you’re covered by your spouse’s insurance) is still working for a firm with 20 or more employees, the employer’s insurance is your primary coverage, and Medicare is secondary and can fill any gaps in coverage. You aren’t required to sign up for Medicare at 65, and you won’t have a late-enrollment penalty as long as you sign up within eight months of leaving your job and losing work-based coverage (or losing coverage under your spouse’s insurance). If you work for a large employer and are happy with its coverage, you may decide to delay signing up for Part B. (Many people still sign up for Medicare Part A at 65.) But the rules are different if you work for a company with fewer than 20 employees. In that case, Medicare generally becomes your primary coverage at age 65, and you need to sign up for Part A and Part B while you’re still working. Some small employers negotiate with insurers to keep employee coverage primary for workers after age 65, but this is unusual; get it in writing from your boss before you delay signing up.

Also note that you can’t delay signing up for Part A if you’re already receiving Social Security benefits and were automatically enrolled in Medicare—even if you’re still working." I have a health savings account at work.

Can I still contribute to my health savings account after I turn 65?

Yes, as long as you haven’t enrolled in Medicare. If you are able to delay signing up for Medicare parts A and B (see above), you can continue contributing to an HSA. Before you decide, determine whether the HSA’s tax breaks, any employer contributions and other benefits are more valuable than the premium-free Part A coverage. I have retiree health insurance.

Do I need to sign up for Medicare at age 65?

Unless you or your spouse is still working and has current employer coverage, you should sign up for both Medicare Part A and Part B at 65. Retiree coverage can fill gaps in Medicare (which would otherwise require medigap and Part D policies or a Medicare Advantage plan), but it’s secondary to Medicare after age 65, and it may not kick in at all if you don’t sign up for Medicare. Federal retiree coverage is an exception; it remains your primary coverage if you don’t sign up for Medicare, but you will pay a penalty if you decide to sign up for Part B later.

What’s the penalty for not signing up?

You’ll have to pay a late-enrollment penalty of 10% of the Medicare Part B premium for every year you should have had coverage. The penalty applies as long as you receive Medicare benefits. If you miss the initial enrollment period or the eight-month window after you or your spouse stops working, you can only sign up from January through March in any year for coverage to begin July 1.

Why do I need Medigap insurance?

"You still have to pay deductibles and co-payments. Most people buy a Medicare supplement (medigap) policy to pay those costs, plus Part D prescription-drug coverage because Medicare generally doesn’t cover drugs. Or you can sign up for a private Medicare Advantage plan, which provides both medical and drug coverage.

Medigap policies are sold by private insurers and come in 10 standardized versions (A through D; F; G; and K through N). Every medigap plan with the same letter designation must provide the same coverage, even though prices can vary by insurer. You can use any doctor or facility that is covered by Medicare."

How much does Part D Medicare cost?

Part D prescription-drug plans are sold by private insurers and have average premiums of $33 per month. You can compare premiums and out-of-pocket costs for your drugs under each Part D plan in your area by using the Medicare Part D plan finder tool at Trusty.care.

How much does Medicare Advantage cost?

Medicare Advantage plans combine medical and drug coverage and may also provide coverage that isn’t available through Medicare, such as for some dental and vision care. Premiums average $38 per month, which tends to be lower than for medigap plus Part D, but you may have more out-of-pocket costs. The plans usually have a limited network of doctors and hospitals, and you may have higher costs (or no coverage) if you go out of network. You may also need a referral to see a specialist. You can shop for a Medicare Advantage plan at www.medicare.gov/find-a-plan.

I’ve been paying high premiums for my medigap plan. Can I switch to another policy to save money?

"Maybe. There’s a huge price range for medigap policies, and you may be able to save by switching. But depending on your health and the state where you live, your options may be limited. Insurers cannot reject you or charge more because of preexisting conditions if you buy a medigap policy within six months of signing up for Medicare Part B. But after that, your health can affect your costs and coverage options. If you’re still healthy, you may qualify for a better deal with another insurer.

Some insurers will let you switch to a less-comprehensive policy without medical underwriting—for example, to high-deductible plan.

Your state may offer special opportunities to switch, regardless of pre­existing conditions. For example, New Yorkers can switch medigap policies at any time regardless of health. In Missouri, you can switch to another insurer’s version of your letter plan on your policy anniversary. (Learn more from your state health insurance assistance program at www.shiptacenter.org, or call 800-633-4227 for contacts.)"

The doctor I want to use isn’t covered by my Medicare Advantage plan. When can I switch to a different plan?

You generally can’t switch to another Medicare Advantage plan until open enrollment in the fall, which runs from October 15 to December 7, 2018, for 2019 coverage. There are a few exceptions: You can switch plans if you qualify for a special enrollment period, such as if you move to an address that isn’t in your plan’s service area. You can also switch to a Medicare Advantage plan with a five-star quality rating anytime during the year. But there are only 17 five-star plans in the U.S. A new list of five star plans for 2019 will be released in October. If you join a Medicare Advantage plan when you are first eligible for Medicare and switch back to traditional Medicare within 12 months, you can buy a medigap policy and a Part D plan within 63 days of the change. Each year, you can switch from Medicare Advantage back to traditional Medicare and get a Part D drug plan from January 1 to February 14. But you could be rejected or charged more for medigap because of a preexisting condition.

How high must my income be to get snagged by the Medicare high-income surcharge?

"If the total of your adjusted gross income plus tax-exempt interest income is more than $85,000 if you’re single, or $170,000 if you’re married and filing jointly, you have to pay extra for Part B, with monthly premiums of $187.50 to $428.60 in 2017, depending on your income. You’ll also have to pay an extra $13.30 to $76.20 each month for Part D drug coverage.

My doctor prescribed an expensive drug and even with my Part D coverage, I have to pay a lot of the cost out of pocket. What can I do to pay less?

First, ask your doctor if you can use a generic drug or a “therapeutic alternative” that costs less under your plan. Also see if you can reduce co-pays by using a preferred pharmacy (ask your insurer which pharmacies are preferred). Then look for a new Part During open enrollment in the fall. Use the Medicare Plan Finder (www.medicare.gov/find-a-plan) to compare premiums plus out-of-pocket costs for your drugs. See if there are restrictions, such as requiring prior authorization from your provider before covering pricey drugs, or step therapy, which means you have to try less-expensive drugs first, if possible.

After I’m on Medicare, can I use HSA money for medical expenses without paying taxes on it?

Even though you can no longer contribute to an HSA after you sign up for Medicare, you can use money already in the account tax-free for medical expenses. You can also use the HSA money tax-free for Part B, Part D and Medicare Advantage premiums (but not medigap).

My Medicare claim was denied. What can I do?

"First find out why it was denied. It may be a coding error your doctor can fix and resubmit. Or Medicare may cover an expense but not submit the claim to your supplemental insurer (go to www.mymedicare.gov to update this information). Drug coverage may be denied if you didn’t follow procedures for step therapy or prior authorization, but that denial may be reversed when you resubmit the forms.

If that doesn’t work, you have 120 days to appeal the denial. Look on the back of the Medicare summary notice for details, and see www.medicare.gov for more about each level of appeal. You have just 60 days to file an initial appeal for Medicare Advantage or Part D; follow the instructions on the explanation of benefits."

Who is eligible for Medicare?

"Individuals entitled to Social Security retirement insurance and 65 years of age and older; Individuals entitled to Social Security disability benefits for not less than 24 months; Individuals entitled to Railroad Retirement benefits or Railroad Retirement disability benefits; Individuals diagnosed with end stage renal disease; Individuals with ALS; A federal, state or local government employee who is not eligible for Social Security retirement or disability benefits but have worked and paid the Medicare Part A ""hospital insurance"" portion of your FICA taxes for a sufficient period of time. (Federal employees became subject to the hospital insurance portion of FICA in January 1983. Most newly hired state and local employees, not otherwise covered under Social Security, started paying the hospital insurance portion as of April 1986.) Note: Individuals who are not otherwise eligible for Medicare, but who are over age 65 may purchase Medicare coverage by paying a monthly premium.

Medicare eligibility for Social Security and Railroad Retirement beneficiaries begins on the first day of the first month in which the individual attains age 65. This is also the date upon which individuals not otherwise eligible for Medicare are entitled and may purchase coverage.

Individuals receiving Social Security or Railroad Retirement disability benefits become eligible for Medicare coverage in the 25th month of receiving those benefits. Individuals who have end stage renal disease usually become eligible on the first day of the third month of a course of renal dialysis treatments. Individuals with ALS (Lou Gehrig’s disease) become eligible when they are eligible for Social Security disability benefits, without a twenty-four month waiting period."

How do you apply for Medicare?

"Individuals receiving Social Security retirement or disability benefits, or railroad retirement checks, will be sent information by the Social Security Administration (SSA) a few months before becoming eligible for Medicare. Residents of one of the 50 states, Washington, D.C., the Northern Mariana Islands, Guam, American Samoa, or the U.S. Virgin Islands, will automatically be enrolled in Medicare Parts A and B by SSA. However, because there is a premium payment required for Part B coverage, beneficiaries may make the choice to turn it down.

While participation in Medicare is voluntary, one should think through the serious consequences of not applying, primarily late enrollment fees and health risks if no other health insurance is available. The costs of premiums alone should not be an overriding factor in one’s decision to participate in the Medicare program. " Are residents of Puerto Rico eligible for Medicare? Residents of Puerto Rico must apply for Medicare. It is not automatic. When do you enroll in Medicare? If you’re not already getting retirement or disability benefits, you may contact Social Security to sign up online for Medicare during your "Initial Enrollment Period," the three months before your 65th birthday,your birth month, and the three months after. You can sign up for Medicare even if you don’t plan to retire at age 65.

Why Does My Doctor No Longer Accept Medicare?

A doctor or provider may decide to “opt out” of Medicare for various reasons; for example, a practice may feel the need to reduce overhead costs or wish to keep the number of patients down in order to maintain a suitable level of care.

What Happens If My Doctor Leaves My Medicare Advantage Plan Network?

If your doctor opts out of Medicare, this means that he or she is no longer enrolled in the Medicare program and does not submit any claims to the federal program or Medicare health plans. The doctor becomes exempt from Medicare-approved spending limits, and you become responsible for paying the complete cost of your health care if you stay with that doctor.

What happens if I go to an out of network doctor?

Your costs are generally lowest if you get your services from a Medicare-participating doctor or provider. Participating providers agree to “accept assignment” for all Medicare-covered services, meaning that they will not charge you above the Medicare-approved amounts for a service. You’ll still be responsible for any cost sharing that may apply, such as copayments, coinsurance, or deductibles.

How do I find an in network doctor?

If you’re enrolled in Original Medicare and your doctor opts out of the Medicare program, you can find doctors who accept Medicare through Medicare.gov’s Physician Compare website. This site is a national database of physicians, specialists, and other health-care professionals who are enrolled in the Medicare program. The site includes both participating and non-participating providers, but you can choose to filter your search to only display doctors that accept assignment.

Can doctors stop taking Medicare Advantage? "

A doctor or provider may decide to “opt out” of Medicare for various reasons; for example, a practice may feel the need to reduce overhead costs or wish to keep the number of patients down in order to maintain a suitable level of care.

If your doctor opts out of Medicare, this means that he or she is no longer enrolled in the Medicare program and does not submit any claims to the federal program or Medicare health plans. The doctor becomes exempt from Medicare-approved spending limits, and you become responsible for paying the complete cost of your health care if you stay with that doctor.

Your costs are generally lowest if you get your services from a Medicare-participating doctor or provider. Participating providers agree to “accept assignment” for all Medicare-covered services, meaning that they will not charge you above the Medicare-approved amounts for a service. You’ll still be responsible for any cost sharing that may apply, such as copayments, coinsurance, or deductibles.

There may be other situations where your doctor remains in the Medicare program, but can choose on a case-by-case basis whether or not to accept Medicare assignment. This is known as a non-participating provider. If a doctor does not accept Medicare assignment for a given service, it means he or she does not accept the Medicare-approved cost amount and can charge you up to 15% more for their services. This is known as a “limiting charge.”

Original Medicare (Part A and Part B) If you’re enrolled in Original Medicare and your doctor opts out of the Medicare program, you can find doctors who accept Medicare through Medicare.gov’s Physician Compare website. This site is a national database of physicians, specialists, and other health-care professionals who are enrolled in the Medicare program. The site includes both participating and non-participating providers, but you can choose to filter your search to only display doctors that accept assignment.

The Physician Compare tool lets you search for doctors and providers by:

Location and zip code Area of practice (for example, cardiology) Gender Hospital affiliation Your doctor’s last name After entering in your search criteria, the Physician Compare page will display a list of doctors in your area that meet your requirements. Before settling on a doctor, you should first call to confirm that he or she accepts Medicare assignment and is taking new patients.

Medicare Advantage plans (Part C) If you are enrolled in a Medicare Advantage plan (such as an HMO or PPO), your plan can make changes to its provider network anytime throughout the year. Your doctor and providers may also join or leave your plan’s network at any time. If your doctor leaves your Medicare Advantage plan’s provider network and you’d like to continue seeing him or her, you have a few options." will medicare advantage plans be eliminated Medicare Advantage plans are subject to change every year. Your doctor or specilaitst of choice could opt out of your network so always check the details of your plans during Open Enrollment Periods. will medicare advantage be discontinued No, Medicare Advantage plans have played an increasingly larger role in the Medicare program as the share of Medicare beneficiaries enrolled in Medicare Advantage has steadily climbed over the past decade.

Will trumpcare affect medicare advantage plans

The two-year budget agreement reached by Congress in February 2018, for the first time, allows Medicare Advantage plans to pay for some long-term supports and services. MA can now include nonmedical services, such as home-delivered meals or rides to a doctor, in their benefit packages.

When will 2019 medicare advantage plans be available?

Open enrollment is over for 2018 coverage, you have to wait until Oct. 15, 2018 to Dec. 7, 2018, to review your coverage and make any changes for 2019 coverae.

What medicare advantage plans cover dental

There are quite a few plans to choose from, with a wide range of premiums and coverage options.

What's medicare advantage

Medicare Advantage (Part C) plans are provided by private insurers and combine coverage for hospital care, doctor visits and other medical services all in one plan. Plans are required to provide all of the benefits offered by Medicare Parts A and B (except hospice care, which continues to be provided by Part A). Many plans also provide prescription drug coverage and additional benefits like routine dental and eye care.

What's medicare advantage plan

A medicare plan that includes a specific group of providers and hospitals. Medicare Advantage is offered by private insurers, unlike traditional Medicare. The plans may also include perscription drug coverage, vision and dental services. how medicare advantage works Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are offered by private companies approved by Medicare. You'll get your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan and not Original Medicare. how medicare advantage plans work Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are offered by private companies approved by Medicare. ... You'll get your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan and not Original Medicare.