February 28th 2024
By Ari Parker
Medicare can be SO confusing! That’s why we’re here to help. Get answers to the most common Medicare questions and find support from our licensed Advisors.
By Ari Parker
The Medicare maze and Medicare mystification are common phrases used by people trying to understand the ins and outs of Medicare. The truth is that Medicare can feel incredibly confusing. And understanding and choosing your coverage can feel overwhelming—but it doesn’t have to! Below, you’ll find answers to many of the most common Medicare questions.
If you’re having trouble wrapping your head around Medicare at any point though, our licensed Medicare Advisors are a phone call away! Give us a call at (855) 900-2427 for free support and advice to help you understand, choose, and use your Medicare insurance. We’ll help make your options clear and make enrollment feel as easy as A, B, C. Speaking of A, B, and C…let’s start by answering some simple questions about the different parts of Medicare.
There are four parts of Medicare: Part A, Part B, Part C, and Part D. There’s also Medicare Supplement coverage. To make the “Medicare alphabet soup” even more confusing, each of these Parts often goes by multiple names. Below, we answer basic questions about Medicare and its different parts. You can also read our overview of Medicare here.
Medicare is federal health insurance for people who are 65 or older. Some people under 65 are eligible if they have certain disabilities, like End Stage Renal Disease or ALS.
Medicare provides affordable health insurance for older Americans and Medicaid provides affordable healthcare insurance for low-income Americans. In some cases, individuals may be "dually eligible," meaning they're eligible for both Medicare and Medicaid. Learn more about how Medicare and Medicaid work together.
Original Medicare, which is also commonly called Traditional Medicare, includes Part A and Part B. Original Medicare is funded by the federal government and is the most widely accepted insurance in the US. About 90% of US doctors accept Medicare. Learn more about Original/Traditional Medicare here.
Medicare Part A is your hospital insurance. It covers inpatient care, which is care from a doctor or nurse after being admitted for at least one night. Part A is free for Americans who have worked and paid Medicare taxes for 10 years (and their spouses). Learn more about Medicare Part A here.
Medicare Part B covers outpatient care—for anything that doesn’t require you to stay overnight. It can include medically necessary healthcare as well as preventative care. Learn more about Medicare Part B here.
Medicare Part C, also known as Medicare Advantage, is a bundled option for your Medicare coverage. By law, Part C plans must cover at least the same services and equipment as Part A and Part B. They generally provide additional benefits, like coverage for prescriptions, dental care, vision services, and hearing aids—but they also come with drawbacks.
Medicare Part D covers prescription drugs, which are not covered by Original Medicare.
Medicare Supplement (Medigap) plans sit on top of Original Medicare and help to cover the remaining 20% of costs not covered by Original Medicare. There are ten Medicare Supplement plans, and each one is required to provide the same coverage, regardless of the insurance carrier. Learn more about Medicare Supplement here.
Medicare Supplement insurance (also known as Medigap) plans sit on top of Original Medicare (Parts A & B) to significantly reduce your out-of-pocket costs. Medicare Advantage, on the other hand, is a bundled approach to Medicare and covers the same services as Original Medicare. Medicare Advantage plans often come with prescription drug coverage and other benefits included.
Here are a few key factors to keep in mind:
Medicare Supplement plans are accepted by any doctor who accepts Original Medicare and Medicare Advantage plans generally have more limitations around which doctors you can see
Enrollment periods are different for Medicare Advantage and Medicare Supplement.
Learn more about Medicare Advantage vs Medicare Supplement here.
Medicare costs vary widely from person to person and are largely dependent on where you live and the coverage you choose. The typical Medicare beneficiary can expect to pay somewhere between $200-$400 each month on premiums. Learn more about Medicare costs here.
You should also keep out-of-pocket costs in mind! Some Medicare health insurance options will reduce your out-of-pocket costs, so it’s important to look at the big picture of all expected healthcare costs when comparing Medicare plans.
Medicare Savings Programs are Medicaid-run programs that provide financial assistance to dually eligible Medicare beneficiaries. If you’re eligible for a Medicare Savings Program, you may also be able to enroll in a Dual Eligible Special Needs Plan (D-SNP), which will provide you with more benefits. Learn more about Medicare Savings Programs here.
There are specific times during which you can enroll in Medicare, and unfortunately, missing deadlines can sometimes result in late enrollment penalties that you’ll have to pay for as long as you have Medicare! To make things more complicated, certain coverage options have different enrollment rules. If you need help understanding when you can enroll, we’re happy to help! Give us a call at (855) 900-2427 to get help with anything related to Medicare.
If you’re already drawing from Social Security, you’ll be automatically enrolled in Medicare. You can confirm enrollment by:
Checking your status via your Medicare account or Social Security account online
Calling the Social Security Administration
If you are not automatically enrolled, contact Social Security to sign up to avoid late enrollment fees.
If your coverage is from an employer group health plan and your employer has 20 or more employees, you (and your spouse) can wait to sign up for Medicare. If not, you should sign up when you turn 65 to avoid late enrollment penalties.
Most people enroll in Part A as soon as they turn 65, regardless of their employment, because Part A is free for those who have worked and paid taxes for 10+ years. We encourage you to compare the costs of your employer coverage with what you’d pay on Medicare to determine if you should enroll in Part B—and we can help with that! Learn more about Medicare enrollment for those who are still working here.
If you have a disability or chronic condition, including End-Stage Renal Disease or ALS, you may be eligible to receive Medicare before you turn 65. Not sure if you’re eligible? Call us any time at (855) 900-2427 to get help determining your eligibility.
Medicare generally provides high-quality, affordable health insurance to older Americans. However, there are some key areas of care that aren’t generally covered—at least under Original Medicare. Some healthcare services are not covered under Original Medicare, but may be covered under some Medicare Advantage plans. That leaves many people with questions about what is and is not covered under Medicare.
Unfortunately, the answer isn’t always black and white and your specific Medicare coverage may not cover something your friend’s plan does. If you’re ever unsure about whether or not something is covered, we’re here to help! Give us a call at (855) 900-2427 with any questions—yes, any! And rest assured that our advice and support is always free.
Medicare doesn’t automatically cover prescription drugs. You can sign up for a Part D (Prescription Drug) plan or a Medicare Advantage plan that comes with Part D benefits to get coverage for your prescriptions.
Vision coverage is handled differently depending on what type(s) of Medicare you have. Original Medicare doesn’t cover corrective lenses and only covers medically necessary eye care, like cataract surgery. Many Medicare Advantage plans provide additional vision benefits, but coverage varies. Learn more about Medicare vision coverage in this article.
Original Medicare generally doesn’t cover dental care services. Many Medicare Advantage plans cover some preventative and restorative care.
Original Medicare doesn’t cover hearing aids, but some Medicare Advantage plans will help cover some of the costs of hearing aids. Learn more about Medicare hearing aid coverage here.
Medicare doesn’t generally cover at-home care unless you have a doctor’s order and are homebound. Before you begin home health care, the home health agency should tell you how much Medicare will pay and which services provided are not covered. Make sure you receive an Advanced Beneficiary Notice before receiving care to ensure you don’t get a surprise bill!
Some services aren’t covered by Original Medicare but are covered by some (not all) Medicare Advantage plans. Understanding what is and is not covered—and what you’ll have to pay—can be confusing because it’s different for everyone. If you’re ever unsure about whether or not something is covered, we’re here to help! Give us a call at (855) 900-2427 with any questions—yes, any! And rest assured that our advice and support is always free.
