What exactly are Medicare beneficiaries asking?
Medicare is an essential part of every American citizen’s life. It’s only natural that you have questions. That’s why we compiled the most common questions about Medicare based on search engine queries made with Google.
Here’s what’s on everyone’s minds, organized by search volume.
How Do I Apply for Medicare?
You can apply for Medicare enrollment in three ways:
- Apply online
- Apply over the phone
- Apply in person
When you apply for Medicare, you will need some basic information about yourself. You should also have in mind what kind of Medicare plan you want. We recommend applying online or over the phone if possible. You can apply in person at your local Social Security office.
You might also be automatically enrolled in Medicare if you:
- Are drawing on Social Security benefits by age 65
- Are disabled and have received disability for 24 months
- Are diagnosed with ALS or ESRD
Always double-check anything that is automatic. You can verify your status by calling the Medicare hotline 1-800-MEDICARE.
Be sure to either enroll in Medicare during your Initial Enrollment Period or properly postpone your enrollment. Failing to do so can cost you a late enrollment penalty of 10 percent for every 12 months of tardiness.
How Much Does Medicare Cost in 2020?
Medicare Part A doesn’t cost anything as long as you qualify for Medicare Part A benefits. If you don’t qualify for premium-free, you can purchase Medicare Part A by paying a Medicare premium. In 2020, you can be charged a maximum of $458 a month for Medicare Part A. Qualification is based on work credits, similar to Social Security.
|Work Credits||Medicare Part A Cost|
|40 or more||Premium-free|
|Less than 30||$458|
Source: U.S. Centers for Medicare & Medicaid Services via Medicare.gov
The standard Medicare Part B premium is $144.60 a month. You may pay a higher or lower premium depending on your income bracket.
Medicare Part C and Medicare Part D premium costs vary widely by plan, coverage, and location. You’ll need to compare plan costs in your area to get an accurate estimate.
Finally, you will also need to cover the costs of co-payments, coinsurance, and deductibles.
What Is Medicare?
Medicare is a health insurance program administered by the federal government. However, the hospitals and doctors are part of the private sector. Original Medicare was introduced in 1965 as a way to provide seniors with affordable health care. Since its introduction, several additional Medicare products, such as Medicare Advantage, have been introduced to expand coverage.
Every year, the Centers for Medicare and Medicaid Services reviews Medicare coverage and adjusts its rules. For example, in 2020, Medicare expanded its coverage to include pain management services via acupuncture.
What Does Medicare Cover?
Medicare is made up of a few parts, and these parts cover different health needs:
- Medicare Part A covers hospital stays and inpatient care, including hospice and skilled nursing facilities.
- Medicare Part B covers medically necessary services and care, like your annual exam.
- Medicare Part C is a Medicare plan regulated by the federal government but serviced and administered by a private health insurance company.
- Medicare Part D covers prescription drugs and is administered by a private health insurance company.
However, Medicare doesn’t cover everything. Hearing, vision, and dental are often not covered by Original Medicare. But you can purchase stand-alone hearing, vision, and dental plans. Some Medicare Advantage plans cover hearing, vision, or dental, but often at an additional cost.
Additionally, you can purchase a Medigap plan to help cover the costs of Original Medicare.
Who Can Get Medicare?
You must be at least 65 to qualify for Medicare. However, certain health conditions can make you eligible for Medicare early. These include end-stage renal disease (ESRD) and amyotrophic lateral sclerosis (ALS). You can also qualify if you’ve been drawing disability for 24 months.
Medicare is available to the following people:
- US citizens
- Permanent residents who have been permanent residents for five years or more
When Can I Get Medicare?
Unless you qualify for early Medicare benefits, you can get Medicare when you are 65. You can enroll as early as three months before your 65th birthday, but coverage doesn’t begin until the first day of the month of your birthday.
You also don’t have to join Medicare immediately. If you get employer healthcare from a company of 25 or more, you can postpone your enrollment. Just be sure to do it the right way. Mistakes can cost you a premium increase of 10 percent or more!
If you have been diagnosed with amyotrophic lateral sclerosis (ALS), you can get Medicare as soon as you qualify for Social Security. You don’t have a waiting period, and you should be automatically enrolled. Always verify your enrollment.
If you have been diagnosed with end-stage renal disease, you can get Medicare when you begin dialysis. You’ll need to complete self-dialysis training to enroll quickly. You also qualify the month of your kidney transplant or two months prior, if you are hospitalized in preparation for your surgery.
If you are drawing disability benefits, you qualify for Medicare after 24 months.
What Is Medicare Part C and What Does a Part C Plan Cover?
Also known as Medicare Advantage, Medicare Part C is a Medicare health plan that’s regulated by the federal government but administered by a private health insurance company. Medicare Part C must cover everything that Original Medicare covers, but it can offer additional coverage. Some people choose a Medicare Advantage plan over Original Medicare because of the extra benefits the Medicare Advantage plan offers.
What Is Medicare Part B and What Does a Part B Plan Cover?
Medicare Part B is one part of Original Medicare and is often referred to as your “medical insurance.” Part B covers your doctor visits, preventive services, and other medically necessary outpatient visits. Not every office visit is covered by Part B, so you should read your plan carefully.
An advantage of Medicare Part B is that you typically don’t need a referral to receive coverage for a visit to a specialist. Your specialist just has to accept Medicare. But don’t forget that you’ll almost always pay a co-payment or coinsurance.
What Is Medicare Part A and What Does a Part A Plan Cover?
Medicare Part A is the other part of Original Medicare and is often referred to as your “hospital insurance.” It covers your inpatient expenses, such as:
- Hospital stays
- Skilled nursing facilities
- Hospice care
- Nursing homes
- (Rarer) In-home nursing care
What Is Medicare Part D and What Does a Part D Plan Cover?
Medicare Part D is also known as your prescription drug plan. It’s a health plan that is regulated by the government but administered by a private health insurance company. Every plan must cover certain medications, as set by the CMS.
However, every plan varies as to which medications it covers—referred to as its formulary—and the tiers to which it assigns each drug.
There are four tiers—first, second, third, and specialty—arranged by cost. The cost is lowest for the first tier, gradually increasing in price to the most expensive on the specialty tier.
How Does Medicare Work?
Your Medicare plan will either be administered by the federal government or a private insurer regulated by the federal government. Either way, a few things are true:
- You typically pay for each service either through a co-pay or coinsurance or both.
- You typically must meet your deductible before receiving additional benefits. However, there is commonly no out-of-pocket maximum—unless you have a Medicare Advantage plan or Medigap.
- Your doctor, nurse, or medical caregiver will typically file your Medicare claim for you.
- You typically pay a premium every month, whether you have Original Medicare or Medicare Advantage.
How Medicare Works FAQ
Can I keep my doctor or go to any doctor?
You can go to any doctor who accepts Medicare, provided that you have Original Medicare. If you have a Medicare Advantage plan, you will likely need to go to a doctor in your network.
Do I need a primary care doctor?
If you have Original Medicare, you do not need to have a primary care doctor, but your doctors must accept Medicare. If you have a Medicare Advantage plan, you will likely need a primary care doctor.
Do I need a referral to see a specialist?
If you have Original Medicare, you do not need a referral to see a specialist, but your specialist must accept Medicare. If you have Medicare Advantage, you will likely need a referral from your primary care doctor.
Is there an out-of-pocket maximum when using Medicare?
Unfortunately, Original Medicare does not have an out-of-pocket maximum for its beneficiaries. That’s why many people with Original Medicare add a Medigap plan to their healthcare plan. However, many Medicare Advantage plans do come with out-of-pocket maximums to keep your costs in check. The particulars will depend on the plan you choose.
Should I get a Medicare Supplement plan?
Medicare Supplement insurance, often called Medigap, is a great way to help manage your healthcare expenses. You can sign up for a Medigap policy if you have Original Medicare, but not if you have Medicare Advantage.
What’s the Difference Between Medicare and Medicaid?
Medicare is a national healthcare program intended for seniors and people with some health conditions. Medicaid is a healthcare assistance program intended to provide healthcare to people of all ages with low income. Medicare is a federal health insurance program, while Medicaid is a state health insurance program. Low-income seniors may qualify for both Medicare and Medicaid.
What Is Medicare Open Enrollment?
This terminology can be confusing, but it helps to remember that Open Enrollment only applies to people already enrolled in Medicare—at least Parts A and B or C. According to the CMS, “Open Enrollment” can refer to two periods:
- Open Enrollment Period
- Medicare Advantage Open Enrollment Period
Open Enrollment Period
Sometimes called the Annual Election Period (AEP), Open Enrollment runs from October 15 to December 7 every year. During this time, a few things happen:
- Medicare health plans and prescription drug plans change each year. The CMS and private health insurance companies declare the changes for the following year every fall.
- You receive notice of your coverage terms and notice of any changes to your Medicare program(s) beginning next year. These notices are called the “Evidence of Coverage” (EOC) and “Annual Notice of Change” (ANOC).
- You can make changes to your Medicare health plan.
- You should review the Medicare insurance plans and plan options available in your area—in case you’d like to change your plan.
There are quite a few changes that you can make to your plan during this time. These are:
- Swap your Medicare Advantage plan for an Original Medicare plan.
- Swap your Original Medicare plan for a Medicare Advantage plan.
- Swap your Medicare Advantage plan with a different Medicare Advantage plan.
- Enroll in a Medicare Prescription Drug plan.
- Swap your Medicare Prescription Drug plan with a different Medicare Prescription Drug plan.
- Disenroll from a Medicare Prescription Drug plan without enrolling in a new one.
Medicare Advantage Open Enrollment Period
Running from January 1 to March 31, the Medicare Advantage Open Enrollment Period offers you the opportunity to:
- Swap your Medicare Advantage plan without prescription drug coverage for one with prescription drug coverage.
- Swap your Medicare Advantage plan for an Original Medicare plan.
- Enroll in a Medicare Prescription Drug plan—if you’re enrolled in Medicare Advantage.
However, you lose the opportunity to:
- Swap your Original Medicare plan for a Medicare Advantage plan.
- Enroll in a Medicare Prescription Drug plan if you’re enrolled in Original Medicare.
- Swap your Medicare Prescription Drug plan for another if you’re enrolled in Original Medicare.
What Is Medicare Plan F?
Medicare Plan F is a Medigap plan that helps you pay Original Medicare co-pays, coinsurance, and deductibles. You pay a monthly premium for Medicare Plan F, and a private health insurance company administers the plan.
Important note: Medicare Plan F is no longer available for new Medicare beneficiaries enrolling on or after January 1, 2020. If you’re currently enrolled in Medicare Plan F, you can keep your plan. But if you drop Medicare Plan F, you cannot re-enroll.
If you’re new to Medicare, you can check out other Medigap plans:
- Medigap Plan A
- Medigap Plan B
- Medigap Plan D
- Medigap Plan G
- Medigap Plan K
- Medigap Plan L
- Medigap Plan M
- Medigap Plan N
How Is Medicare Funded?
Medicare is funded through two US Treasury trust funds:
- The Hospital Insurance Trust Fund is funded through payroll taxes, trust fund investment gains, Part A premiums paid by people ineligible for premium-free policies, and income tax paid on Social Security benefits.
- The Supplementary Medical Insurance Trust Fund is funded by Congress, trust fund investment gains, and Part B premiums paid by beneficiaries.
How Many People Are on Medicare?
According to the Centers for Medicare and Medicaid Services (CMS), there are between 60 and 65 million Medicare beneficiaries. This number fluctuates every month.
How Do I Get a Medicare Replacement Card?
You can replace your Medicare Card three ways:
- Request a new card online by logging into your Social Security account on the Social Security website, SSA.gov.
- Request a new card over the phone by calling 1-800-MEDICARE or TTY 1-877-486-2048.
- Request a new card in person at your local Social Security office.*
*Due to the COVID-19 pandemic, we recommend that you do not request a new card in person. If possible, use the online or over-the-phone methods instead.
How Long Does It Take to Get Medicare Part B After Applying?
That depends on when you sign up. If you sign up before your 65th birthday, you will need to wait until the first day of the month of your birthday for your Medicare benefits to begin.
If you sign up the month of your 65th birthday—or any of the three months after your 65th birthday—your coverage begins on the first day of the month after you sign up.
If you enroll during the General Enrollment Period (January 1 to March 31), your coverage begins July 1 of that year.
If you sign up for Medicare due to an illness or disability, your coverage begins the first day of the month you’re eligible. Be sure to check on the status of your enrollment if you’re enrolled automatically.
What Is the Medicare Deductible for 2020?
The Medicare deductibles for 2020 are:
- $1,408 for Medicare Part A
- $198 for Medicare Part B
The Medicare deductibles for 2019 were:
- $1,364 for Medicare Part A
- $185 for Medicare Part B
What Does Medicare Not Cover?
Medicare doesn’t cover everything, and that can come as a surprise to new Medicare beneficiaries. Services not covered by Medicare include:
- Custodial or long-term care
- Cosmetic surgery
You’ll also find limited coverage for chiropractic and acupuncture services. However, Medicare coverage is almost always expanding, with new services or extended services offered every year.
What Is the Donut Hole in Medicare?
If you’re signed up for a Medicare Prescription Drug plan, your plan works like this: You pay for prescription drugs up to your deductible of $310 (or less depending on your plan). Afterward, you pay 25 percent of your drug costs until you reach the annual spending limit of $2,800—that includes the total of what you and your plan provider have spent on your medications.
After reaching that mile marker, you’re responsible for 100 percent of your prescription costs until you reach the out-of-pocket maximum spending limit of $4,550 (or less depending on your plan). After this, you’ll be responsible for 5 percent of your costs or less.
That’s a lot of money, and that gap in coverage is called the “donut hole.”
How do I fix the “donut hole” effect?
In the past, beneficiaries either had to pay high premiums to get more prescription drug coverage or struggle to cover the out-of-pocket expenses. This lead to many instances of:
- Choosing to cover prescription costs and falling behind on rent and other bills.
- Rationing lifesaving medications.
- Forgoing taking lifesaving medications because they’re unaffordable.
Thanks to the Affordable Care Act and progressive healthcare legislation, the donut hole effect has received serious reform. As of 2020, you’ll pay 25 percent coinsurance for your prescriptions until you reach the out-of-pocket maximum spending limit of $4,550.
Even with reform, some people struggle to cover medications. For them, there is the Medicare Extra Help program. Extra Help offers you financial assistance for your prescription drug plan premiums and medication costs.
Conclusion: Know Your Healthcare
Getting the best Medicare healthcare comes down to studying and understanding the Medicare health system. Begin with the basics like these and create time in your schedule to review your Evidence of Coverage (EOC) and Annual Notice of Change (ANOC) documents each year.