Medicare Basics

Shawn Plummer, CRPC

Chartered Retirement Planning Counselor

What is Medicare?

Medicare is a federal health insurance program primarily designed for seniors aged 65 and older. It also caters to younger individuals with specific disabilities and those with end-stage renal disease or permanent kidney failure.

Example: Mrs. Green, 67, recently retired. As she navigated her post-retirement life, she realized her healthcare costs were increasing. Thanks to Medicare, she can ensure robust health coverage without breaking the bank.

Key Takeaways

Medicare’s Structure: Medicare is broken down into several parts, each covering different healthcare aspects:

  • Part A: Covers inpatient hospital care, skilled nursing facility care, and some home health care. Most people don’t pay a premium for Part A.
  • Part B: Covers doctors’ services, outpatient care, and some preventive services. It comes with a standard monthly premium that could be higher based on income.
  • Part C (Medicare Advantage Plans): These are alternative plans offered by private companies, combining Part A and Part B, and often Part D. They may include extra benefits at an additional cost.
  • Part D: Offers prescription drug coverage and is run by Medicare-approved private insurers. Costs vary by plan and income.
  • Medicare Supplement Insurance (Medigap): For costs not covered by original Medicare, individuals can purchase Medigap policies. These help pay for out-of-pocket costs such as copayments, coinsurance, and deductibles.
Medicare

The Four Parts of Medicare

Medicare isn’t a one-size-fits-all solution. It’s divided into different sections, each catering to varied health needs.

  • Medicare Part A (Hospital Insurance): Medicare Part A covers hospital costs and helps cover inpatient care in hospitals, skilled nursing facilities, hospice care, and sometimes, home health services.
  • Medicare Part B (Medical Insurance): Medicare Part B covers doctors’ services, outpatient care, medical supplies, and preventive services.
  • Medicare Part C (Medicare Advantage): Medicare Part C is offered by private insurance companies; Medicare Advantage plans are an alternative to Original Medicare (Parts A and B). They often include additional benefits like dental services, hearing aids, and sometimes even prescription drug coverage.
  • Medicare Part D (Prescription Drug Coverage): Medicare Part D is purely for covering prescription drug costs. To get this, one must enroll in a plan offered by an insurance company or other private entity approved by Medicare.
Best Medicare Plan

Medicare vs. Medicaid

Certainly! Medicaid and Medicare are both government-sponsored health insurance programs in the United States, but they serve different populations and have different benefits, eligibility requirements, and funding sources. Here’s a basic comparison table:

FeatureMedicaidMedicare
Eligibility– Low-income individuals and families– Individuals aged 65 and older
– Some disabled individuals– Some younger individuals with disabilities
– Pregnant women– People with End-Stage Renal Disease (ESRD)
Funding– Jointly funded by state and federal government– Funded by federal government
Parts/Programs– Varies by state– Part A: Hospital Insurance
– Part B: Medical Insurance
– Part C: Medicare Advantage
– Part D: Prescription Drug Coverage
Costs– Often no or low cost– Premiums, deductibles, and co-pays can apply
Coverage– Hospital and medical services– Hospital stays, doctor visits, and more
Long-term care for elderly and disabled– Prescription drugs (Part D)
– Some states include dental, vision, and more
Enrollment– Can apply anytime– Specific enrollment periods
Duration– As long as eligibility criteria are met– Generally lifelong

It’s important to note that the specifics of Medicaid can vary by state, as states have some flexibility in how they design their programs within federal guidelines. Additionally, Medicare has various plans and options that can affect coverage and costs. Always consult with a healthcare professional or advisor for detailed and personalized information.

Who Can Help Me Choose A Medicare Plan

How Much Are Premiums, Taxes, and Benefits

Medicare isn’t entirely free. Beneficiaries usually pay monthly premiums, especially for Part B and Part D. How much Medicare pays and what beneficiaries pay (out-of-pocket costs) depends on several factors.

  • Medicare Premiums: This is a monthly fee that some people pay to the federal government.
  • Medicare Taxes: While working, you probably had Medicare taxes deducted from your payroll. This is what funds the Medicare program.
  • Medicare Payments: Depending on your Medicare plan, the program will pay a share of the costs of your healthcare services. The remaining balance might be covered by supplemental insurance or will be an out-of-pocket expense.

Example: Ms. Smith noticed deductions in her paycheck for Medicare. Now at 70, she avails of several health care services, with a significant portion covered by the Medicare payments, reducing her financial burden.

What Is Medicare

When Can I Enroll In Medicare

Enrollment isn’t automatic unless you’re already receiving social security benefits. The initial enrollment period begins three months before you turn 65 and lasts until three months after your 65th birthday. Late enrollment can lead to higher premiums.

Example: Mr. Walker, unaware of the enrollment period, missed his initial window. He later discovered that enrolling on time would have saved him a significant amount on his monthly premiums.

Medicare Definition

Conclusion

Medicare is an invaluable resource, a testament to the joint federal commitment to its citizens’ health and well-being. Whether you’re approaching the golden age of 65 or assisting a loved one in their health journey, understanding Medicare is imperative. After all, it’s not just about health coverage; it’s about ensuring peace of mind in an often tumultuous healthcare landscape. With its diverse parts and supplemental coverage options, Medicare stands as a pillar of support for millions. And now, equipped with this knowledge, you’re better prepared to navigate its many avenues.

Medicare Provides

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Frequently Asked Questions

Is anyone eligible for Medicare?

Most individuals aged 65 or older, and some younger individuals with specific disabilities or medical conditions, are eligible for Medicare in the United States.

Do I automatically get Medicare when I turn 65?

If you already receive Social Security benefits, you will typically be enrolled in Medicare automatically when you turn 65. Otherwise, you must sign up for Medicare during your Initial Enrollment Period.

What are the 4 types of Medicare?

The four types of Medicare are: 1) Part A (Hospital Insurance), 2) Part B (Medical Insurance), 3) Part C (Medicare Advantage), and 4) Part D (Prescription Drug Coverage).

How do I get a Medicare card?

To get a Medicare card, you need to be eligible for Medicare. If you’re automatically enrolled, the card will be mailed to you three months before your 65th birthday or after your 25th month of disability benefits. Otherwise, you can apply online or visit your local Social Security office.

What is a Medicare savings account?

A Medicare Savings Account (MSA) is a Medicare Advantage Plan that combines a high-deductible health plan with a medical savings account. Simply put, it is an account you can use to pay for your healthcare services before your insurance starts covering them.

What disabilities qualify you for early Medicare?

After 24 months of receiving Social Security Disability Insurance (SSDI) benefits, you’ll automatically qualify.

Does Medicare cover funeral expenses?

While Medicare does not cover funeral expenses, there are several ways that people on Medicare can get help with paying for their funeral. One option is to purchase a life insurance policy that will pay out upon the policyholder’s death. This type of life insurance policy is called final expense or burial insurance. Another option is to set up a funeral trust, an account used to pay for funeral expenses.

Does Medicare pay for nursing homes?

While Medicare does offer some coverage for nursing home care, its scope is limited. Medicare typically covers skilled nursing care, physical therapy, speech-language pathology services, and occupational therapy for 100 days.

How long will Medicare pay for nursing home stays?

Medicare Part A will cover skilled nursing care under specific conditions for a limited time. Here’s a breakdown:
Days 1-20: Medicare will pay the total cost for each benefit period.
Days 21-100: For each benefit period, you pay a daily co-payment (which can vary from year to year), and Medicare covers the rest.
Days 101 and beyond: Medicare will not pay; you are responsible for all costs.

Does Medicare cover palliative care?

Medicare Part A and Part B do provide coverage for palliative care. This includes doctor and nurse visits, physical or occupational therapies, and some prescription medications to ease symptoms.

Does Medicare pay for assisted living?

No, Medicare does not pay for assisted living or other long-term care facilities. Long-term care insurance is a good alternative.

What’s The Average Cost Of Supplemental Insurance For Medicare?

The average cost of supplemental insurance for Medicare, often called Medigap, varies widely based on the plan type, region, and insurance company. Premiums typically range from $50 to $300 per month. However, checking current rates and comparing providers for accurate figures is essential.

What Is Medicare For Long-Term Care?

Medicare provides limited coverage for long-term care. It primarily covers short-term skilled nursing or rehabilitation services following a hospital stay. Medicare does not pay for extended custodial care, such as assistance with daily living activities. Individuals often rely on Medicaid, private insurance, or personal savings for prolonged long-term care.

Does Medicare Cover Assisted Living Costs?

No, Medicare does not cover the costs of assisted living facilities or long-term custodial care. Medicare mainly covers hospital care, medical services, and short-term post-hospital skilled nursing or rehabilitation. If they qualify, individuals often look to personal savings, long-term care insurance, or Medicaid for assisted living expenses.

Does Medicare Part B pay for assisted living?

No, Medicare Part B doesn’t cover assisted living.

Does Medicare Part B pay for nursing homes?

No, Part B doesn’t cover long-term nursing home care.

Does Medicare pay for cremation?

No, Medicare doesn’t cover funeral or cremation costs.

Does Medicare pay for a home assistant?

No, but it may cover home health services.

Does Medicare pay for home health aides?

Yes, if medically necessary and under specific conditions.

Does Medicare pay for long-term care?

No, it doesn’t cover long-term care.

Does Medicare pay for senior daycare?

No, it doesn’t cover adult daycare.

Does Medicare pay for skilled nursing?

Yes, for a limited time after a qualifying hospital stay.

How do I get Medicare to pay for an ambulance?

If medically necessary, Medicare Part B may cover it.

How do I get Medicare to pay for a caregiver?

Medicare doesn’t typically cover caregiver services.

How do I get Medicare to pay for home care?

Must be homebound and require skilled services.

How do I get Medicare to pay for incontinence supplies?

Generally, Medicare doesn’t cover incontinence supplies.

How do I pay for Medicare without social security?

You can pay directly, through bank drafts, or Medicare Easy Pay.

How do I pay social security and Medicare taxes for self-employed?

Through the Self-Employment Tax using Schedule SE with your tax return.

How do you pay for Medicare?

Through Social Security deductions or direct payments.

How do you pay for Medicare Part B without collecting social security?

Direct billing, bank draft, or Medicare Easy Pay.

How does Medicare pay as a secondary payer?

After the primary insurance is paid, Medicare pays its share of the remaining costs.

How long does Medicare pay for a nursing home?

Up to 100 days after a 3-day qualifying hospital stay.

How long does Medicare pay for dialysis?

It covers dialysis indefinitely, but terms can vary.

How long does Medicare pay for hospice?

As long as the patient meets the hospice criteria.

How long does Medicare pay for inpatient psychiatric care?

Up to 190 days in a lifetime.

How long does Medicare pay for rehab?

After a qualifying hospital stay, up to 100 days in a skilled nursing facility.

How long does Medicare pay for rehab after hip replacement?

Up to 100 days if criteria are met.

How long will Medicare pay for CPAP supplies?

Indefinitely, but supplies are replaced at specific intervals.

How long will Medicare pay for home health care?

As long as you’re eligible and the services are medically necessary.

How long will Medicare pay for immunotherapy?

As long as it’s deemed medically necessary.

How many days does Medicare pay for a skilled nursing facility?

Up to 100 days after a 3-day qualifying hospital stay.

How many therapy sessions does Medicare pay for?

As many as deemed medically necessary, but there may be limits.

How many times will Medicare pay for rehab?

There is no set limit, but each time must meet the criteria.

How much does Medicare Part B pay for physician fees?

Typically 80% after the deductible is met.

How much do you pay for Medicare?

Varies by income and specific medicare plan; Part B premium was $148.50/month in 2021.

How much does Medicare pay?

Varies by service; often 80% for Part B services after deductible.

How much does Medicare pay for a chiropractic adjustment?

Covers manual manipulation of the spine if medically necessary.

How much does Medicare pay for air ambulance?

If medically necessary, Part B may cover it; the patient pays 20%.

How much does Medicare pay for Alzheimer’s care?

It doesn’t cover long-term care but may cover some services and treatments.

How much does Medicare pay for assisted living?

Doesn’t cover assisted living facility costs.

How much does Medicare pay for cataract surgery?

Part B covers surgery and intraocular lens; the patient pays 20%.

How much does Medicare pay for family caregivers?

Doesn’t pay family caregivers but may cover home health services.

How much does Medicare pay for freestyle libre?

Part B may cover it if the criteria are met; the patient pays 20%.

How much does Medicare pay for glasses after cataract surgery?

Provides an allowance towards standard frames/lenses.

How much does Medicare pay for hearing aids?

Doesn’t cover hearing aids.

How much does Medicare pay for home health care per hour?

Doesn’t pay per hour; covers services if criteria are met.

How much does Medicare pay for hospice per day?

Covers hospice care; the exact amount can vary.

How much does Medicare pay for hospital stays?

Part A covers inpatient stays; the patient pays the deductible.

How much does Medicare pay for hospital stays per day?

Depends on the length of stay; deductible for the first 60 days in 2021.

How much does Medicare pay for laser cataract surgery?

Covers basic surgery costs; patients may pay extra for laser.

How much does Medicare pay for long-term nursing home care?

Doesn’t cover long-term care; it covers limited skilled nursing care.

How much does Medicare pay for memory care facilities?

Doesn’t cover memory care facilities.

How much does Medicare pay for nursing homes?

Covers up to 100 days after a qualifying hospital stay.

How much does Medicare pay for outpatient surgery?

Part B covers it; the patient typically pays 20% after the deductible.

How much does Medicare pay for physical therapy?

Part B covers it; the patient pays 20% after the deductible.

How much did Medicare pay for physical therapy in 2022?

Part B covers it; exact amounts can vary yearly.

How much does Medicare pay for physical therapy per visit?

Part B covers it; the patient pays 20% after the deductible.

How much does Medicare pay for portable oxygen concentrators?

Part B covers it if medically necessary; the patient pays 20%.

How much does Medicare pay for Remicade infusions?

Part B may cover it; the patient pays 20% after the deductible.

How much does Medicare pay for urgent care visits?

Part B covers it; the patient typically pays 20% after the deductible.

How much does the government pay Medicare Advantage plans?

Varies: the government pays a set amount to plans for each enrollee.

How much will I pay for Medicare?

Depends on income and a specific plan.

How much will Medicare pay for total knee replacement?

Parts A & B cover it; the patient is responsible for deductibles and coinsurance.

How often does Medicare pay for a new glucose meter?

Every 5 years if medically necessary.

How often does Medicare pay for a colonoscopy?

Once every 10 years for routine screening; more often if high risk.

How often does Medicare pay for eye exams?

Every 12 months for diabetes; doesn’t cover routine exams.

How often does Medicare pay for gynecological exams?

Pelvic exams every 24 months; annually if at risk.

How often does Medicare pay for mammograms?

Screening mammograms every 12 months.

How often does Medicare pay for mammograms after age 70?

Every 12 months.

How often does Medicare pay for podiatry?

If medically necessary due to diabetes or other conditions.

How often does Medicare pay for respite care?

As part of the hospice benefit, limits apply.

How often will Medicare pay for a walker?

When medically necessary, typically every 5 years.

How often will Medicare pay for a wheelchair?

When medically necessary, typically every 5 years.

How often will Medicare pay for an MRI?

When medically necessary, there is no set limit.

How often will Medicare pay for blood tests?

When medically necessary, some screenings are annual.

How often will Medicare pay for prolia injections?

Every 6 months if criteria are met.

How to get Medicare to pay for dental implants?

Medicare doesn’t typically cover dental implants.

How to get Medicare to pay for eyelid surgery?

Only if it’s medically necessary, not for cosmetic reasons.

How to pay for assisted living with Medicare?

Medicare doesn’t cover assisted living; consider other funding sources.

How to pay for Medicare Part B?

Social Security deductions, direct billing, or bank drafts.

How do I pay Medicare online?

Through Medicare Easy Pay or your bank’s online service.

How do you pay Medicare premiums?

Social Security deductions, direct billing, bank drafts, or Medicare Easy Pay.

What does Medicare Part A pay for?

Inpatient hospital stays, skilled nursing facility care, hospice, and some home health care.

What does Medicare Part B pay for?

Outpatient care, doctor’s services, preventive services, and some home health care.

What does Medicare pay?

Varies by service; often 80% for Part B services after deductible.

What does Medicare pay for?

Hospital care, doctor visits, preventive services, and more, depending on the part.

What equipment does Medicare pay for?

Durable medical equipment like wheelchairs, walkers, and oxygen if medically necessary.

What kind of bed will Medicare pay for?

Hospital beds if medically necessary.

Why do I have to pay Medicare tax?

To fund the Medicare program for current and future beneficiaries. It is also a federal requirement.

Why do I pay for Medicare?

To cover your share of the program’s costs.

Why do I pay Medicare tax if I don’t have insurance?

Medicare tax funds the program for current beneficiaries; you’ll benefit when eligible.

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Shawn Plummer, CRPC

Chartered Retirement Planning Counselor

Shawn Plummer is a Chartered Retirement Planning Counselor, insurance agent, and annuity broker with over 14 years of first-hand experience with annuities and insurance. Since beginning his journey in 2009, he has been pivotal in selling and educating about annuities and insurance products. Still, he has also played an instrumental role in training financial advisors for a prestigious Fortune Global 500 insurance company, Allianz. His insights and expertise have made him a sought-after voice in the industry, leading to features in renowned publications such as Time Magazine, Bloomberg, Entrepreneur, Yahoo! Finance, MSN, SmartAsset, The Simple Dollar, U.S. News and World Report, Women’s Health Magazine, and many more. Shawn’s driving ambition? To simplify retirement planning, he ensures his clients understand their choices and secure the best insurance coverage at unbeatable rates.

The Annuity Expert is an independent online insurance agency servicing consumers across the United States. The goal is to help you take the guesswork out of retirement planning and find the best insurance coverage at the cheapest rates

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