Frequently Asked Questions About
Medicare
What is Medicare?
As a United States citizen who has reached the age of 65 or above, you have the opportunity to enroll in Medicare, the federally provided healthcare program.
Medicare consists of Parts A and B, commonly known as Original Medicare, which provide coverage for fundamental hospital and doctor expenses.
However, Original Medicare leaves certain expenses uncovered, resulting in potential out-of-pocket expenses. To safeguard against these gaps in coverage, Medicare supplements or Medicare Advantage plans are available, offering additional protection.
How does Medicare work?
Medicare is a federal health insurance program that provides coverage for eligible individuals, primarily those aged 65 and older, as well as certain younger individuals with disabilities or specific medical conditions.
Medicare is divided into four different parts:
- Part A (Hospital Insurance)
- Part B (Medical Insurance)
- Part C (Medicare Advantage)
- Part D (Prescription Drug Coverage)
Medicare enrollment occurs during specific periods, and there are costs involved such as deductibles and copayments.
What is the difference between Medicare Part A and Medicare Part B?
Medicare Part A covers inpatient hospital care, skilled nursing facility care, hospice care, and some home health services. Most people don’t have to pay for Part A if they or their spouse paid Medicare taxes while working.
Medicare Part B covers outpatient medical services, including doctor visits, preventive care, diagnostic tests, durable medical equipment, and some outpatient treatments. Part B requires a monthly payment.
What is Medicare Part C? How does Medicare Part C work?
Medicare Part C is an alternative way to receive Medicare through private insurance companies approved by Medicare. Medicare Advantage plans often combine coverage for Parts A and B. These plans have their own price and rules.
What is Medicare Part D? How does Medicare Part D work?
Medicare Part D provides coverage for prescription drugs. Part D plans are offered by private insurance companies and can be added to Original Medicare or included in Medicare Advantage plans. Part D plans have their own copayments and formularies (lists of covered drugs).
What is Medigap?
Medigap, also known as Medicare Supplement Insurance, is a private insurance coverage that assists in filling the gaps left by Original Medicare. While Original Medicare covers a substantial portion of the expenses for healthcare services and supplies, it does not cover everything.
By obtaining a Medigap policy, you can alleviate some of the remaining healthcare costs, such as copayments, coinsurance, and deductibles.
Moreover, certain Medigap policies provide coverage for services that are not included in Original Medicare, such as medical care during international travel.
If you have Original Medicare and decide to purchase a Medigap policy, the following process occurs:
- Medicare will cover its portion of the Medicare-Approved Amount for the healthcare costs that are eligible.
- Afterward, your Medigap insurance company will cover its portion of the expenses.
What is the difference between Medigap and Medicare Advantage?
Medicare Advantage integrates Medicare Part A and B, providing a comprehensive coverage solution within a single plan. These plans are also referred to as Part C plans.
Medigap (Medicare Supplment) insurance policies help pay the out-of-pocket expenses not covered by Original Medicare (Part A and B). It is not part of the government’s Medicare program, but provides coverage in addition to it. By obtaining a Medigap policy, you can alleviate some of the remaining healthcare costs, such as copayments, coinsurance, and deductibles. Also some Medigap plans can provide coverage for medical care during international travel.
Who qualifies for Medigap?
Individuals who are eligible for Medicare Parts A and B can qualify for a Medicare Supplement plan, provided they are not enrolled in a Medicare Advantage plan and can pass underwriting.
However, there are circumstances where individuals may qualify for a Medicare Supplement plan without undergoing underwriting:
- Open Enrollment: Open Enrollment is a six-month period that begins in the first month someone is enrolled in Part B. During this period, there is no underwriting required to qualify for a Medicare Supplement plan. This means that pre-existing conditions do not disqualify individuals, and they can change their policy as many times as needed within this six-month window.
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Guaranteed Issue applies to those who have involuntarily lost creditable coverage. This window allows for a period of 60 days before and 63 days after the end of coverage to qualify for certain Medicare Supplement plans without undergoing underwriting. Similar to Open Enrollment, individuals can change their policy as many times as necessary during this timeframe. This situation typically arises when moving to a new service area or experiencing changes to existing coverage.