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Top 6 Things You Need to Know About Medicare Healthcare Coverage

Top 6 Things You Need to Know About Medicare Healthcare Coverage

If you are on Medicare or will be soon and want to learn a few things about what’s ahead, you’ve come to the right place. The Medicare Family has a few tips you will want to know about when tackling Medicare healthcare coverage.

1. What Is Medicare Insurance?

Medicare is a form of health insurance paid for by the federal government. It is available to citizens of the United States who are 65 years of age and older and provides coverage for services such as doctor visits and hospital stays. It also includes coverage for skilled nursing, outpatient services, and durable medical equipment.

2. The Four Parts of Medicare Health Coverage

Part A

Hospital Insurance – this section covers some of your medical costs while in a hospital or skilled nursing facility, as well as hospice and home health care. 

Part B

Medical Insurance – this section covers outpatient care, including doctors’ visits, office tests like x-rays and blood work, as well as preventive services like “wellness” checks and vaccinations. In addition, it also covers durable medical equipment expenses such as wheelchairs and walkers.

Part C

Medicare Advantage Plans – plans from private insurers that bundle Medicare Part A, B, and often D and may offer some extra benefits like vision, hearing, and dental care not covered with Original Medicare.

Part D

Prescription Drug Coverage – this section covers the cost of prescription drugs but is run by private insurance companies following specific Medicare guidelines.

3. Requirements for Joining Medicare Healthcare Coverage

Young woman helping senior
  • You are a citizen of the United States.
  • You are 65 years of age or older.
  • Under age 65 with certain qualifying conditions or disabilities.
  • You live in the country legally.
  • In order to qualify for premium-free Part A, you must have paid into Medicare out of your FICA payroll taxes for at least 10 years.

4. When Is the Deadline for Enrolling in Medicare Insurance?

The Initial Enrollment Period (IEP) for Medicare starts three months before your 65th birthday and continues for three months after your birthday month, for a total of seven months. Unless you have other creditable coverage, such as employer group health insurance, you need to sign up, even if you’re in good health, as there may be penalties for delaying.

5. When to Delay Enrolling in Medicare Health Coverage Part B

If you have insurance through an employer, spouse’s employer, or some other private insurance plan, those policies may be your primary coverage. In any of those cases, you can delay enrolling in Part B Medicare and not end up paying for duplicate coverage. Make sure to weigh the benefits and costs of each path before choosing one over the other. You also have the option of carrying multiple policies.

Be aware that there may be a penalty to enroll later unless your existing coverage was deemed “Creditable Coverage”.

6. Understand What Kind of Medicare Insurance Package You Need

Tips You Need to Know About Medicare Healthcare Coverage

There are many different combinations of coverage from which you can choose. 

You can make a more informed decision after determining what kind of coverage you want and need by considering the following:

Know the Bottom-Line Costs of the Different Health Insurance Plans

You can choose from many plans, but one might cost less or more to purchase, depending on your situation. If you don’t choose the right strategy and sign up later, your costs may increase significantly

Have an Idea of the Costs That You Might Incur

Understanding the costs of different policies is crucial, but also take into account your current health care needs like doctor’s visits and prescriptions. Although no one likes to think about it, you also need to consider escalating health needs in the future and see how the different options pan out in each of those potential scenarios.

Explore Your Prescription Drug Options and Costs

It is essential to choose a plan that covers your prescription drugs. Ask if you can go to any pharmacy or if you will have to use only certain pharmacies. You should also find out what the cost of your medication will be. Make sure you’re signing up for the plan with the best coverage that works with your budget.

Consider the Enrollment Timing

Since there are no monthly premiums with Medicare Part A, there is no need to delay that enrollment. However, if you have existing coverage or health conditions, each insurance portion’s enrollment timing could affect your total premiums.

Learn What the Benefits Are and How to Use Them

There are a lot of benefits that come with Medicare health insurance coverage. You need to understand what all of these benefits are and how you can take advantage of them. Be sure to ask for help from a professional advisor if you need to learn about all the different options.

Health insurance coverage is essential as it can help pay for medical and health care expenses, including prescription medications, dental care, and vision care. Medicare health coverage options are plentiful, and many plans offer different packages of services with varying price tags that may or may not cover all these services. 

However, knowing what kind of benefits you need before you enroll in your Medicare health insurance coverage will lead you to the most beneficial and cost-effective decisions. For expertise and advice, contact The Medicare Family today.

Sylvia Gordon, aka Medicare Mama®, is an expert on all things Medicare and Social Security. She is the 2nd Generation here at The Medicare Family and has served on the advisory boards of major insurance companies like UnitedHealthcare®, Cigna, and Anthem. In her free time, she can be found taking care of her animals (dogs, goats, peacocks, chickens), and reading a good book. Learn More.
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