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Original Medicare Coverage FAQ

What is Original Medicare?

Original Medicare includes two parts: Medicare Part A (covering hospital expenses) and Medicare Part B (providing medical coverage). It's a national health insurance plan for people aged 65 and above, those under 65 with specific disabilities, and anyone, regardless of age, diagnosed with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease.

What is Original Medicare Part A?

What is Original Medicare Part B?

Is Medicare the same as Medicaid?

Medicare and Medicaid are government programs that help cover healthcare costs, but they're different. Medicare is for people 65 or older or those with certain disabilities, and it's run by the federal government. Medicaid, on the other hand, is a mix of state and federal programs. It's for individuals and families with low incomes. If you're eligible for both Medicare and Medicaid, you're called Dual Eligible.

Can I get my prescription drugs covered under Original Medicare?

No, Original Medicare doesn't include prescription drug coverage. While Part A might cover certain drugs received during a hospital stay, you need to get prescription drug coverage separately. This is known as Medicare Part D, which you can obtain through private insurance companies approved by Medicare. You can opt for either a standalone Part D plan (PDP) or a Medicare Advantage plan (MAPD) that incorporates prescription drug benefits.

Does Original Medicare cover vision, dental or hearing care?

Usually, no. Original Medicare typically doesn't include routine dental or vision care, eyeglasses, or hearing aids. However, Part B might cover some dental or vision services if they're medically necessary and you meet specific conditions, but it's essential to confirm with your healthcare provider and Medicare beforehand. Many Medicare Advantage (Part C) plans do provide these benefits, so it's wise to compare all plan options to find the coverage that suits your needs best.

Does Original Medicare pay for a nursing home stay?

Medicare Advantage FAQ

What is a Medicare Advantage Plan?

Medicare Advantage plans (Part C) bundle Parts A, B, and D into one plan. They offer all the benefits of Medicare Part A and of Medicare Part B. Additionally, Medicare Advantage plans may include Prescription drug coverage (Part D), regular vision, dental, and hearing care, fitness perks and wellness programs and other extras. Keep in mind, not all plans are offered in every area.

What's the difference between a Medicare Advantage Plan and a Medicare Supplement Plan?

Medicare Advantage and Medicare Supplement plans are distinct, and you can't enroll in both simultaneously. Medicare Advantage (Part C) integrates Part A, Part B, and often Part D (prescription drug) coverage into one plan. They may offer extra benefits like hearing, vision, dental, and fitness, and they have an annual limit on out-of-pocket expenses for covered services. Medicare Supplement (Medigap) plans assist with certain out-of-pocket costs that Original Medicare doesn’t cover, such as coinsurance and copayments.

Prescription Drug Plan FAQ

What is a Medicare Part D Plan?

Medicare Part D is about prescription drug coverage. These plans, known as PDP, assist with the costs of medications prescribed by your doctor. They're offered by private insurance companies authorized by Medicare. The U.S. government decides which drugs are covered, but beyond that, each Part D plan covers a unique set of medications. It's crucial to ensure that the plan you choose includes the drugs you need. Most Medicare Advantage Plans (Part C) already incorporate Part D prescription drug coverage, bundled with hospital and medical coverage. Alternatively, you can opt for a separate Part D plan alongside Original Medicare, a Medicare Supplement Insurance plan, or a Private Fee-For-Service plan.

How do I know if my drugs are covered by the Medicare Part D Plan?

Medicare Supplement FAQ

What is Medicare Supplement Insurance?

Medicare Supplement insurance plans, provided by private insurance companies, assist with covering certain out-of-pocket expenses that Original Medicare (comprising Part A and Part B) doesn't cover. These plans are also referred to as Medigap plans.

When can I apply for Medicare Supplement Insurance?

The ideal time to sign up for a Medicare Supplement plan is during your Medicare Supplement Open Enrollment period because you're guaranteed acceptance. This period begins on the first day of the month when you turn 65 and enroll in Medicare Part B. Some states have their own Open Enrollment periods and Guaranteed Issue rules. If you apply outside of these periods, you might be denied coverage or charged higher rates based on your health history. However, residents of Connecticut and New York have ongoing Open Enrollment and Guaranteed Issue, ensuring Medicare Supplement plans are always available.

How much Medicare Supplement Insurance coverage do I need?

There are ten standardized Medicare Supplement insurance plans, all designed to help cover out-of-pocket expenses for Medicare-approved services. Some plans offer more extensive coverage but come with higher monthly premiums, while others cover fewer costs with lower premiums. The specific benefits and costs vary depending on the plan you choose. Plans C and F are exclusively available to individuals eligible for Part A or those who turned 65 before January 1, 2020. If you apply outside of this period or another guaranteed issue window, you might face denial of coverage or higher premiums based on your health history. However, residents of Connecticut and New York have ongoing guaranteed issue, ensuring Medicare Supplement plans are always accessible.

Does a Medicare Supplement Insurance Plan replace Original Medicare Part A and Part B?

No, a Medicare Supplement insurance plan works alongside Original Medicare, which includes Part A and Part B. It helps cover some of the healthcare costs that Original Medicare doesn’t pay for. For example, Medicare Part B typically covers about 80% of Part B expenses, leaving you responsible for the remaining portion. A Medicare Supplement insurance plan could help cover your share. If you apply outside of the enrollment period or another guaranteed issue window, you might face denial of coverage or higher premiums based on your health history. However, residents of Connecticut and New York have ongoing guaranteed issue, ensuring Medicare Supplement plans are always accessible.

Limited Income & Resources?

You may be able to get help from your state with other Medicare costs under the Medicare Savings Program.

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Medicare Eligibility FAQ

When am I eligible for Original Medicare?

Once you reach 65 years old and are a U.S. citizen or legal resident, you qualify for Original Medicare. If you're a legal resident, you need to have resided continuously in the United States for at least five years before becoming eligible for Original Medicare.

I'm not 65 yet. Could I still be eligible for Original Medicare?

Am I eligible for a Medicare Advantage or Medicare Prescription Drug Plan?

Certainly, but you need to sign up for Medicare Part A and/or Part B. To apply for a Medicare Advantage (Part C) plan, you must have both Medicare Part A and Part B. For Medicare Part D prescription drug plans, you must first enroll in either Medicare Part A or Part B. You can't be refused enrollment in a Part D plan. To avoid the late enrollment penalty for Part D, you must enroll in a Part D plan during your Initial Enrollment Period unless you qualify for a Special Enrollment Period.

Medicare & Working Past 65 FAQ

What if I'm 65, but I'm still working? Do I still need to sign up for Medicare?

Even if you're still employed when you reach 65, you'll need to think about Original Medicare, even if you already have coverage through your employer's health plan. At 65, you might consider signing up for Medicare Part A, which doesn't have a premium. If your employer provides qualified insurance, you might be able to postpone enrolling in Part B and Part D without facing penalties. However, you might still need to enroll when you turn 65. To understand your options better, speak with your employer's benefit administrator.

What if I get Health Insurance under my working spouse?

Medicare Enrollment FAQ

When do I need to enroll in Original Medicare?

If you're about to turn 65 and already get Social Security or Railroad Retirement Board benefits, you'll automatically get enrolled in Original Medicare Parts A and B. But if you're not getting these benefits yet when you turn 65, you need to sign up during your Initial Enrollment Period.

How do I enroll in Original Medicare?

What is the Medicare Initial Enrollment Period?

What is a Medicare Special Enrollment Period?

Medicare provides a Special Enrollment Period (SEP) for various situations, such as working past 65 with credible employer coverage or experiencing certain qualifying events. If you're working past 65, you have eight months to enroll in Medicare Part A and Part B. However, you only have the first two months of this period to sign up for a Medicare Advantage (Part C) or Part D plan without facing penalties. For those already enrolled in Medicare, there's a separate 2-month SEP for experiencing qualifying life events. For instance, if you move to a different state where your Medicare Advantage plan isn't available, you qualify for this SEP. During these two months, you can switch Medicare Advantage or Part D plans, or return to Original Medicare if you prefer.

What is the Medicare Advantage Open Enrollment Period?

What if I want to change plans?

Medicare Costs FAQ

How much does Original Medicare Part A and Part B cost?

Understanding Medicare costs is crucial. Typically, there's no premium for Original Medicare Part A. However, the premium for Original Medicare Part B varies depending on your income and can change annually. Both Part A and Part B also come with deductibles and coinsurance. You might qualify for assistance with these Medicare costs.

How much do I have to pay for Medicare Part D Plans?

There are some costs associated with Medicare Part D plans. Stand-alone Part D plans offered through a private insurance company, like UnitedHealthcare, charge a monthly premium. You could also consider Medicare Advantage (Part C) that includes Part D coverage under a single plan. Some plans also require you to pay an annual deductible and coinsurance or copayment amounts. Medicaid and the Extra Help program, if you qualify for them, can also help cover costs of prescription drugs.

What is Extra Help?

What is the Donut Hole?