Medicare is our nation’s insurance program for older adults and for people who have disabilities. While over 61 million people are enrolled in Medicare, the benefit is a bit of a mystery to some beneficiaries. The program has several parts, from A to D, and each covers different care and services. It’s no wonder seniors and their adult children find it so confusing.
To help people learn more, we tackle some of the most commonly asked questions.
What Seniors and Adult Children Should Know About Medicare
Q: What are the differences between Medicare Parts A and B?
A: One of the easiest ways to keep these two parts of Medicare straight is to think of A as hospital/inpatient insurance and B as medical insurance. Part A of the Medicare benefit covers hospital stays, skilled nursing and rehabilitation center care, home health care and hospice. Part B helps pay for physician office visits, preventative care (e.g., mammograms and flu shots), durable medical equipment and other outpatient services.
Q: Do you have to pay for Medicare Part B? If so, how much does it cost?
A: Yes, there is a monthly premium for Part B if you opt to enroll. In 2023, the standard Medicare Part B premium is $164.90. Most seniors pay this amount, but those with incomes of $97,000 or higher might pay more.
Q: What is the difference between Medicare and Medicaid?
A: Because the names of these two programs are so similar, people often confuse them. But there are significant differences, which we’ve summarized below:
• Medicaid: This means-tested health program is for low-income people of all ages. It is a federal program, but eligibility criteria and program administration are handled at the state level.
• Medicare: Medicare is a federal program that beneficiaries pay into over the course of their working lives. Most people receive Part A at no cost and can elect to purchase additional coverages through Parts B and D.
Q: What are the age criteria for Medicare eligibility?
A: For most people, Medicare eligibility begins at 65 years old. There are, however, some exceptions. If you are under 65 but have been receiving Social Security disability for 24 months or more, you are probably eligible for Medicare. People with some medical conditions, such as permanent kidney failure or amyotrophic lateral sclerosis (ALS), typically qualify at a younger age.
Q: How often do I have the option to change my Medicare plan if I’m not happy with what I have?
A: Every fall, Medicare hosts open enrollment from October 15 through December 7. During this time, recipients can make changes to their plans. Seniors and family members who are assisting them with this process should take their time exploring all the current plans and coverages. They’ll also want to review the Annual Notice of Change (ANOC) that Medicare requires health plans to send out in the fall to alert recipients to any changes. Providers drop in and out of Medicare, so it’s important to confirm your preferred hospitals and physicians will continue to participate.
Q: Am I required to sign up for Medicare Part D?
A: Seniors who don’t take any medications often wonder if they need to enroll in Medicare Part D, the part of the benefit that covers prescriptions. While most beneficiaries aren’t required to sign up, you will have to pay a monthly penalty if you do enroll down the road. That’s currently 1% of the monthly premium multiplied by the number of months you didn’t have creditable prescription coverage. It’s why financial planners generally say it’s best to sign up for a Medicare Part D plan when you first enroll.
Q: Does Medicare pay for all of a recipient’s health care expenses?
A: Unfortunately, no. Medicare has deductibles and limits that enrollees are responsible to pay. The exception might be if you opt for a Medicare Advantage plan. Some of these do pay for all medical expenses, but you’ll want to thoroughly vet the provider to be sure. If you opt for traditional Medicare, it is usually best to purchase additional coverage, known as a Medigap policy. It will help bridge the gap in coverage.
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We hope this information has helped to clarify the Medicare benefit and shared some ways you can make the most of it. To learn more about American Senior Communities, visit our website.