FAQs Medicare

Original Medicare pays for many, but not all, health care services and supplies. Medicare Supplement Insurance policies, sold by private companies, can help pay some of the health care costs that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles. Medicare Supplement Insurance policies are also called Medigap policies. Some Medigap policies also offer coverage for services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. Generally, Medigap policies don’t cover long-term care (like care in a nursing home), vision or dental care, hearing aids, eyeglasses, or private-duty nursing.

A Special Enrollment Period is a period of time when an individual can join or switch Medicare Part D or Medicare Advantage plans outside of the annual Open Enrollment Period (also called the OEP or Annual Election Period or AEP).  The annual Open Enrollment Period for Medicare Part D and Medicare Advantage plans begins each year on October 15th and continues through December 7th – with coverage beginning January 1st of the next year.

If you (or your spouse) are still working, you may have a chance to sign up for Medicare during a Special Enrollment Period. If you didn’t sign up for Part B (or Part A if you have to buy it) when you were first eligible because you’re covered under a group health plan based on current employment (your own, a spouse’s, or if you’re disabled, a family member’s), you can sign up for Part A and/or Part B: ■ Anytime you’re still covered by the group health plan ■ During the 8-month period that begins the month after the employment ends or the coverage ends, whichever happens first 24 Section 2—Signing Up for Medicare Part A and Part B Usually, you don’t pay a late enrollment penalty if you sign up during a Special Enrollment Period. This Special Enrollment Period doesn’t apply to people with End-Stage Renal Disease (ESRD). Note: If you’re disabled, the employer offering the group health plan must have 100 or more employees to get a Special Enrollment Period.

For Medicare Advantage (also known as Medicare Part C) and Medicare prescription drug plans, there’s an Annual Election Period (AEP) when you can sign up for, change, or disenroll from the plan. The AEP runs from October 15 to December 7 each year.

Medicare beneficiaries can qualify for Extra Help with their Medicare prescription drug plan costs. … To qualify for the Extra Help, a person must be receiving Medicare, have limited resources and income, and reside in one of the 50 States or the District of Columbia. Information on the Extra Help program.

Extra Help with Medicare Prescription Drug Plan Costs – Social Security

Medicare Part D, also called the Medicare prescription drug benefit, is a United States federal-government program to subsidize the costs of prescription drugs and prescription drug insurance premiums for Medicare beneficiaries.

Medicare Advantage Plans must cover all of the services that Original Medicare covers except hospice care. Original Medicare covers hospice care even if you’re in a Medicare Advantage Plan. In all types of Medicare Advantage Plans, you’re always covered for emergency and urgently needed care.

The plan can choose not to cover the costs of services that aren’t medically necessary under Medicare. If you’re not sure whether a service is covered, check with your provider before you get the service.

Medicare Advantage Plans may offer extra coverage, like vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D). In addition to your Part B premium, you usually pay a monthly premium for the Medicare Advantage Plan.

In 2017, the standard Part B premium amount is $134 (or higher depending on your income). However, most people who get Social Security benefits pay less than this amount ($109 on average).

If you need a service that the plan says isn’t medically necessary, you may have to pay all the costs of the service. But, you have the right to appeal the decision.

You can also ask the plan for a written advance coverage decision to make sure a service is medically necessary and will be covered. If the plan won’t pay for a service you think you need, you’ll have to pay all of the costs if you didn’t ask for an advance coverage decision.

Generally, a plan offered by a private company that contracts with Medicare to provide Part A and Part B benefits to people with Medicare who enroll in the plan. Medicare health plans include all Medicare Advantage Plans, Medicare Cost Plans, and Demonstration/Pilot Programs. Programs of All-inclusive Care for the Elderly (PACE) organizations are special types of Medicare health plans. PACE plans can be offered by public or private entities and provide Part D and other benefits in addition to Part A and Part B benefits.

No, with a few exceptions, most prescriptions aren’t covered. You can add drug coverage by joining a Medicare Prescription Drug Plan (Part D).

In most cases, yes. You can go to any doctor, other health care provider, hospital, or other facility that’s enrolled in Medicare and accepting Medicare patients. Visit Medicare.gov to search for and compare health care providers, hospitals, and facilities in your area.

Original Medicare is one of your health coverage choices as part of Medicare. You’ll have Original Medicare unless you choose a Medicare Advantage Plan (like an HMO or PPO). Original Medicare is coverage managed by the federal government. You generally have to pay a portion of the cost for each service covered by Original Medicare.

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