New to Medicare
Medicare is the federal health insurance program for people 65 and over, some younger with disabilities and those with End Stage Renal Disease. Medicare is a different program from Medicaid, which offers healthcare and services to those who meet the qualified lower income requirements. Anyone receiving Social Security Disability (SSDI) for 24 months, will also become eligible for Medicare.
There are 4 main parts of Medicare and each part works in a unique way to help cover your healthcare expenses.
Parts of Medicare:
Part A – helps cover inpatient hospital stays, skilled nursing facility care, hospice care and home health care.
Part B – designed to help cover services from doctors, outpatient care and preventive services like screenings, shots and wellness visits.
Part C – also known as Medicare Advantage. These plans are offered through private health insurance companies and must provide the same coverage as Original Medicare and may also include additional benefits such as dental, vision, hearing and more.
Part D – provides coverage towards the cost of prescription drugs. You could choose a stand alone Part D plan or it may be included in a Medicare Advantage plan (also known as a MAPD plan).
What does Medicare Pay:
Medicare generally covers 80% of your Part A and Part B medical costs. You are responsible for the remaining 20%. There is no limit on what you pay out of pocket, unless you have Medicare Supplement coverage, also known as Medigap. You could also choose to get your coverage through a Medicare Advantange plan, also known as Part C. It is important to understand how each of these coverages work, when making a decision on how you would like to receive your benefits.
New to Medicare with Employer Coverage:
There are several factors to consider if it makes sense to keep your employer coverage alongside your Medicare or would it be better to leave the employer coverage and choose Medicare as your primary insurance.
A few key questions would include: How large or small is the employer? How much is your monthly premium? Do you perfer a network based plan or would you like to have more freedom to choose any provider that accepts Medicare?
When it comes to Medicare, there is no one size fits all. Knowing your situation and what you find important, provides answers that help determine which road may be more suitable for you.