Medicare FAQs: Your Essential Guide to Understanding Medicare
Navigating Medicare can be challenging, but having the right information at your fingertips can make all the difference. At Nexus Insurance Advisors, we're here to help you understand the complexities of Medicare and ensure you have the coverage you need. Below, we've compiled a list of frequently asked questions (FAQs) about Medicare, designed to answer your most pressing questions and guide you through the process.
1. What is Medicare?
Medicare is a federal health insurance program primarily for people aged 65 and older. It also provides coverage for certain younger individuals with disabilities, as well as those with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS). Medicare is divided into four parts:
Part A: Hospital Insurance
Part B: Medical Insurance
Part C: Medicare Advantage (offered by private companies)
Part D: Prescription Drug Coverage
2. Who is eligible for Medicare?
Most people qualify for Medicare when they turn 65. You may also qualify under 65 if you’ve received Social Security Disability Insurance (SSDI) for 24 months or have specific conditions like ESRD or ALS.
3. What is the difference between Medicare Part A and Part B?
Part A covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care. It is often premium-free if you or your spouse paid Medicare taxes while working.
Part B covers outpatient care, such as doctor visits, preventive services, and medical supplies. Part B requires a monthly premium, which is typically deducted from your Social Security benefits.
4. What is Medicare Advantage (Part C)?
Medicare Advantage, or Part C, is an alternative to Original Medicare (Parts A and B). These plans are offered by private insurance companies approved by Medicare and often include additional benefits like dental, vision, hearing, and prescription drug coverage.
5. What is Medicare Part D?
Medicare Part D provides prescription drug coverage. It helps cover the cost of prescription medications and is available through private insurance companies approved by Medicare. You can enroll in a standalone Part D plan or choose a Medicare Advantage plan that includes drug coverage.
6. When can I enroll in Medicare?
Initial Enrollment Period (IEP): A seven-month period that begins three months before the month you turn 65, includes your birthday month, and ends three months after.
Special Enrollment Period (SEP): If you have coverage through an employer or union, you may qualify for a Special Enrollment Period when that coverage ends.
General Enrollment Period (GEP): Runs from January 1 to March 31 each year, with coverage starting July 1. Penalties may apply for late enrollment.
7. How do I avoid Medicare late enrollment penalties?
To avoid penalties, make sure you enroll in Medicare Parts A, B, and D during your Initial Enrollment Period or when you first become eligible. If you delay enrollment without creditable coverage, you may face penalties that will increase your monthly premiums.
8. Can I change my Medicare plan?
Yes, you can make changes to your Medicare coverage during the Annual Enrollment Period (AEP) from October 15 to December 7. You can switch between Medicare Advantage and Original Medicare, change Medicare Advantage plans, or change Part D plans.
9. What is the Medicare Advantage Open Enrollment Period?
The Medicare Advantage Open Enrollment Period runs from January 1 to March 31. During this time, if you’re already enrolled in a Medicare Advantage plan, you can switch to another Medicare Advantage plan or return to Original Medicare with or without a Part D plan.
10. What does Medicare not cover?
Medicare does not cover everything. Some services and items not covered include:
Long-term care (custodial care)
Most dental care
Eye exams related to prescription glasses
Dentures
Cosmetic surgery
Acupuncture
Hearing aids and exams for fitting them
Routine foot care
You may want to consider supplemental insurance, like a Medicare Supplement (Medigap) plan, to help cover some of these costs.
11. What is a Medicare Supplement (Medigap) plan?
Medicare Supplement plans, also known as Medigap, are offered by private insurance companies and help pay for some of the out-of-pocket costs not covered by Original Medicare, such as copayments, coinsurance, and deductibles. These plans do not include prescription drug coverage.
12. How do I choose the right Medicare plan?
Choosing the right Medicare plan depends on your healthcare needs, budget, and preferences. Consider factors such as:
Your current health and potential future healthcare needs
Prescription medications you take
Whether you want additional benefits like dental, vision, or hearing
Your preferred doctors and hospitals
Costs, including premiums, deductibles, and out-of-pocket expenses
At Nexus Insurance Advisors, we offer personalized assistance to help you compare plans and find the coverage that best suits your needs.
13. How can Nexus Insurance Advisors help me with Medicare?
At Nexus Insurance Advisors, we specialize in helping you navigate the complexities of Medicare. We offer:
Expert advice on Medicare plans and coverage options
Assistance with enrollment and plan changes
Support in understanding and avoiding late enrollment penalties
Personalized service to help you find the best plan for your needs and budget
Our goal is to make the Medicare process as smooth and stress-free as possible, ensuring you have the coverage you need at a cost you can afford.
14. What should I do if I still have questions about Medicare?
If you still have questions or need further assistance, don't hesitate to reach out to Nexus Insurance Advisors. Our team of experienced professionals is here to provide you with the information and support you need to make informed decisions about your Medicare coverage.
