9 Things You Need to Know About Medicare

After years of working and using healthcare from an employer, retirees often have questions about Medicare. Because understanding the program’s benefits and comparing different plans can be overwhelming for new initiates, a quick online search might not uncover the lesser-known details of the Medicare program. 

If different quotes and plans are making your head spin, websites like Offers Club give prospective beneficiaries a big-picture look into Medicare coverage by comparing various plans and pricing for you. Once you’ve done a deep dive into resources like these, look beyond and explore these nine things you need to know about Medicare.

Medicare eligibility varies

Generally, most people become eligible for Medicare benefits when they turn sixty-five. However, Medicare also offers services to people under sixty-five who receive Social Security Disability Insurance. Additionally, you might qualify for Medicare if you have chronic health problems like kidney disease or ALS. 

Medicare enrollment periods are limited

Retirees who want Medicare health coverage have a short window for their initial enrollment period. The government gives retirees seven months to take advantage of the initial enrollment period, beginning in the three months before they turn sixty-five. The rules for people with disabilities are different, so contact a representative if this applies to you.

If you miss your initial enrollment period, all hope is not lost. The program also has a general enrollment period in the first three months of the calendar year and a special enrollment period for people who missed the initial or general periods. 

Not everyone has to sign up for Medicare Parts A and B

To access Medicare Part A and Part B benefits, retirees usually have to sign up. However, if they are already collecting Social Security, the system automatically enrolls them. If you aren’t collecting Social Security benefits, you must sign up through the Social Security Administration.

Everyone collecting Social Security must use the Part A benefits. If they choose not to use Part A, they cannot collect Social Security benefits and must return any money they’ve already received. 

Know the difference between Medicare Parts

Before you decide whether to use both Medicare parts, it’s helpful to know the difference between them. Part A benefits cover hospital expenses. This coverage is free for taxpayers who paid into Medicare for a minimum of ten years.

To cover Medicare Part A expenses, employers and employees pay into the system each with each paycheck. Each group pays 1.45% of wages into the system. People who are self-employed pay the entire 2.9% into the system. Workers who earn over $200,000 pay 0.9% more into the program than workers below the threshold.

Part B pays for doctor and outpatient expenses. This coverage costs about $150 each month. While retirees must take Part A coverage, they can choose to decline Part B coverage, especially if they already have retirement health care coverage from another source. 

Retirees can also take advantage of Part D coverage, which can reduce prescription-drug expenses. For about $30 each month, retirees can pay less for their costly prescription drugs. Retirees do not have to take this benefit, but many find the $30 fee worthwhile. 

Why consider a Medicare Advantage plan

Some private health care organizations offer Medicare Advantage plans. The private insurance companies combine the Medicare plans along with other coverage. Retirees who choose Medicare Advantage plans have co-pays, deductibles, and other typical health care expenses, but they may also have more stringent coverage than Medicare alone.

Before choosing a Medicare Advantage plan, it is wise to investigate whether your providers accept the plan. People with more health problems often benefit from choosing Medicare over Medicare Advantage because more providers accept the original program than combination programs.

Your income determines your costs

Medicare increases monthly expenses on retirees who have high incomes. Retirees who earn more than $88,000 individually or $176,000 combined pay more for Medicare Part B and Part D benefits than those who earn less than those annual amounts. In some situations, the monthly costs are more than double for retirees with substantial income. 

Take advantage of free programs

Retirees and other Medicare users get several free preventative services. These include an annual wellness visit, cardiovascular screening, mammograms, flu shots, and cancer screenings. Catching problems early helps reduce health care expenses, so don’t forget to make your annual appointment. 

Medicare offers telehealth services

Telehealth services became more popular when the COVID-19 pandemic began. To help seniors and other Medicare recipients continue to use their services, the organization increased its convenient telehealth offerings. 

Beneficiaries can use their smartphones at home to access Medicare telehealth services. Keep in mind that the expenses for telehealth visits are the same as in-person visits. Most users pay 20% of the telehealth bill when using their Part B benefits. 

Know what Medicare does not cover

Despite Medicare serving as a health care safety net for retirees, it does not cover all elder care needs. Medicare does not cover dental or eye care, and it won’t pay for devices like dentures or hearing aids.

The program also leaves out long-term care like retirement homes for people who need help with daily tasks. Retirees who need long-term care must turn to their savings, long-term care insurance, or Medicaid.

Wrap up

Medicare is a helpful program that reduces medical expenses for retirees and people with long-term disabilities or chronic health problems. Knowing how the program works and what it covers helps retirees get the most out of their benefits.