What do you want to know?

I know that you have so many things you want to know about Medicare and most of the time you don't want to read long articles. So, I've gathered 10 frequently asked questions to help you around. 

1. What is Medicare?

Medicare is the federal health insurance program for people age 65 and over or certain people younger than 65 with disabilities.  They are also for people with amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease and with end-stage renal disease (ESRD), also known as permanent kidney failure

2. What are the different parts of Medicare?

Medicare is divided into 3 parts; Part A (Hospital Insurance), covering Inpatient care in hospitals, skilled nursing facility care, Hospice care or Home health care. Part B (Medical Insurance), covering services from doctors and other health care providers, outpatient care, home health care, durable medical equipment like a wheelchair, walkers, hospital beds and others and many preventive services like screenings, shots or vaccines and yearly wellness visits. Part D (Prescription Drug Coverage), covers the cost of prescription drugs, including many recommended shots or vaccines. 

3. When should I enroll in Medicare?

If you are eligible, the initial enrollment period starts during the 7-month period that begins 3 months before the month you turn 65. It includes the month you turn 65 and ends 3 months after the month you turn 65. 

After the initial enrollment is over and you haven't signed up yet, you may still have a chance during the Special Enrollment Period. Usually, you don't have to pay a late enrollment penalty if you were able to enroll during this period. However, the Special Enrollment Period doesn't apply to people who are eligible based on End-Stage Renal  Disease. It also does not apply if you're still in your Initial Enrollment Period. 

If you didn't sign up for Part A during your Initial Enrollment Period and Special Enrollment Period, you can sign up during the General Enrollment Period which is every January 01 - March 31 of each year. Your coverage won't start until July 1 of that year, and you may have to pay a higher Part A and/or Part B premium for late enrollment.

4. What is Medigap?

Medigap is also known as Medicare Supplement Plan. They help pay some of the remaining health care costs for covered services and supplies, like copayments, coinsurance, and deductibles. Some Medigap policies offer coverage for services that Original Medicare doesn't cover. However, they do not cover long-term care like care in a nursing home, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.

5. What is Medicare Advantage Plan?

It is also known as Medicare Part C. They are offered by Medicare-approved private companies that must follow rules set by Medicare. They cover almost all Medicare Part A and Part B benefits, however, you'll need to use health care providers that participate in the plan's network.

6. What is the difference between Original Medicare and Medicare Advantage Plan?

In Original Medicare, you can go to any doctor that takes Medicare, anywhere in the U.S. In most cases you do not need a referral to see a specialist. There's no yearly limit on what you pay out-of-pocket unless you have supplemental coverage. You can get supplemental coverage to help pay your remaining out-of-pocket. You don't have to get a service or supply approved ahead of time for it to be covered.

While in the Medicare Advantage Plan, in most cases, you'll need to use doctors who are in the plan's network and you need to get a referral to see a specialist. Plans have a yearly limit on what you pay out-of-pocket for Medicare Part A and B-covered services. Once you'll reach your plan's limit, you'll pay nothing for Part A and Part B -covered services for the rest of the year. You can't buy or use separate supplemental coverage. However, prescription coverage is already included in most plans. And you have to get a service or supply approved ahead of time for it to be covered. 

7. Does Medicare cover Chiropractic?

Yes, but the criteria are extremely specific. Medicare will only cover chiropractic service as long as it is used as a treatment for a condition called spinal subluxation.  You will also need an official diagnosis and a qualifies chiropractor for Medicare to cover this treatment. Some Medicare Advantage plans offer coverage for additional chiropractic care.

8. Does it cover vision?

Medicare does cover certain eye care services if you have a chronic eye condition, such as cataracts or glaucoma. It also covers surgical procedures to help repair the function of the eye due to chronic eye conditions and covers routine eye care in the following circumstances:

• If you have diabetes, for diabetes-related vision problems.
• If you are at high risk for glaucoma.

Routine eye care, such as regular eye examination is not included.

9. Does Medicare cover eyeglasses expenses?

Yes, it covers Eyeglasses or contact expenses if you had an intraocular lens placed in your eye after cataract surgery. Medicare will cover a standard pair of untinted prescription eyeglasses or contacts if you need them. If it is medically necessary, Medicare may pay for customized eyeglasses or contact lenses.

10. How much does Medicare cost?

There will be new rates for the year 2020. The premium will rise by nearly 7% to $144.60 a month, up to $135.50 in 2019.  The annual deductible for Part B coverage, which includes doctor visits and outpatient care, also will go up by 7% to $198 in 2020, an increase of $13 from the annual deductible of $185 in 2019.

For more details regarding the cost of Medicare for this year, 2020, you may check my previous blog post - Medicare Cost for 2020.