1. What is Medicare?

Answer:
Medicare is a federal health insurance program primarily for individuals aged 65 and older, though younger individuals with certain disabilities or conditions may also qualify. It helps cover medical expenses, including hospital stays, doctor visits, and prescription medications.

2. What are the different parts of Medicare?

Answer:
Medicare is divided into four parts:

  • Part A (Hospital Insurance): Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.

  • Part B (Medical Insurance): Covers outpatient care, doctor visits, preventive services, and other medical services.

  • Part C (Medicare Advantage): An alternative to Original Medicare (Part A and Part B) offered by private insurance companies, often including additional benefits like dental, vision, and prescription drug coverage.

  • Part D (Prescription Drug Coverage): Provides prescription drug coverage through private insurance plans.

3. Who is eligible for Medicare?

Answer:
Generally, individuals aged 65 or older are eligible for Medicare. You may also qualify if you are under 65 and have a disability, end-stage renal disease (ESRD), or amyotrophic lateral sclerosis (ALS), regardless of your age.

4. When can I enroll in Medicare?

Answer:
You can enroll in Medicare during the following periods:

  • Initial Enrollment Period (IEP): This is a 7-month window starting 3 months before the month you turn 65, the month you turn 65, and ends 3 months after your 65th birthday.

  • General Enrollment Period (GEP): If you miss your IEP, you can enroll from January 1 to March 31 each year, with coverage starting July 1.

  • Special Enrollment Period (SEP): If you qualify for specific circumstances (e.g., you are covered by a group health plan), you may enroll at any time without penalty.

5. How much does Medicare cost?

Answer:
The costs of Medicare depend on the specific parts you enroll in:

  • Part A is typically free if you or your spouse paid Medicare taxes while working.

  • Part B usually has a standard monthly premium, which can change based on income.

  • Part C and Part D premiums vary depending on the plan you choose. You may also have deductibles, coinsurance, and copayments.

6. What is the Medicare Advantage Plan (Part C)?

Answer:
Medicare Advantage (Part C) is a health plan offered by private companies approved by Medicare. It includes all benefits from Parts A and B, and often includes additional services like dental, vision, and wellness programs. Many plans also include Part D (prescription drug coverage).

7. What does Medicare Part D cover?

Answer:
Medicare Part D provides prescription drug coverage. Part D plans are offered by private insurance companies and help pay for prescription medications. Costs for Part D include monthly premiums, deductibles, and copayments based on the medications you need.

8. Do I need Medicare if I already have health insurance?

Answer:
Even if you have health insurance through an employer or union, you should still sign up for Medicare when you're eligible to avoid late enrollment penalties. If you have employer health coverage, you may not need to enroll immediately, but it’s important to understand how both coverage options work together.

9. What is a Medigap plan?

Answer:
A Medigap plan is supplemental insurance sold by private companies to help pay for costs not covered by Original Medicare (such as copayments, coinsurance, and deductibles). Medigap plans only work with Original Medicare, not Medicare Advantage plans.

10. What happens if I miss the Medicare enrollment deadline?

Answer:
If you miss your Initial Enrollment Period (IEP) and do not qualify for a Special Enrollment Period (SEP), you may have to wait until the General Enrollment Period (GEP) from January 1 to March 31. You might also face late enrollment penalties, and your coverage could be delayed.

11. What is the difference between Original Medicare and Medicare Advantage?

Answer:

  • Original Medicare (Parts A and B) is the traditional government-run program. You can visit any doctor or hospital that accepts Medicare.

  • Medicare Advantage (Part C) is a private health insurance plan that offers the same benefits as Original Medicare, with additional coverage options and possibly lower out-of-pocket costs. However, Medicare Advantage plans typically require you to use a network of doctors and hospitals.

12. Can I change my Medicare plan after enrolling?

Answer:
Yes, you can make changes to your Medicare plan during specific periods:

  • Open Enrollment Period (Oct 15 - Dec 7): You can switch between Original Medicare and Medicare Advantage or change Part D plans.

  • Medicare Advantage Open Enrollment (Jan 1 - Mar 31): If you're in a Medicare Advantage plan, you can switch to a different plan or return to Original Medicare.

13. Do I need to get Part B if I’m still working and have health insurance?

Answer:
If you or your spouse are still working and have employer health insurance, you may not need to enroll in Part B right away. However, you will need to sign up for Part B when your employer insurance ends to avoid late enrollment penalties.

14. Does Medicare cover long-term care?

Answer:
Medicare does not cover long-term care or custodial care, such as assistance with daily living activities like bathing or dressing. It may cover some short-term stays in a skilled nursing facility, but only if you meet certain conditions, such as needing care after a hospital stay.

15. How do I get help with Medicare costs?

Answer:
There are programs that can help with Medicare costs, such as:

  • Medicare Savings Programs: Help pay for premiums, deductibles, and coinsurance.

  • Extra Help: A program that helps people with limited income pay for Medicare Part D prescription drug costs.