12 Medicare Questions You're Too Embarrassed to Ask
Medicare can be complicated. If you have a ton of questions going through your mind, you're not the only one!
Whether you're coming up on your 65th birthday or just exploring your options for the future, we've got you covered.
In this post, we'll be tackling 12 common Medicare questions that are on everyone's mind, hopefully leaving you with a better grasp of the ins and outs of Medicare.
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1. What Is Medicare Anyway?
Medicare is a federal health insurance program that is primarily for individuals aged 65 years and older, as well as younger people with certain qualifying medical conditions.
Medicare is divided into different parts.
- Part A covers hospital stays, skilled nursing facility care, hospice care, as well as some home health care services.
- Part B covers medical such as doctor visits, outpatient care, preventive services, and medical equipment.
- You can add Part D if you want coverage for prescription drugs.
- Alternatively, if you don't want to go with Original Medicare, there are Medicare Advantage plans available, also known as Part C of Medicare.
Medicare Advantage plans are an alternative to Parts A, B, and D and they are only offered through private insurance companies, not the government. Many of them have $0 or low premiums and may include additional benefits like dental, vision, and hearing coverage.
2. That Was Too Long… Can You Explain Medicare to Me Like I'm in Kindergarten?
In simpler terms, Medicare is a health insurance program that helps pay for your health care services like doctor visits, hospital stays, and sometimes prescription drugs after you turn 65.
We only wish it were that easy! In reality, Medicare has many different parts and options to choose from.
So, if you don't fully understand it, it's a good idea to get in touch with licensed sales agents like the ones here at Sams/Hockaday who can help educate you on all of your options.
3. Is Medicare Similar to Medicaid?
While Medicare and Medicaid are both government-run healthcare programs, they have different qualification criteria.
Medicare eligibility is based on age or disability status. It’s available to all Americans after they turn 65, as long as they, or their spouse, have paid Medicare taxes for at least 10 years. Certain younger people with disabilities or End-Stage Renal Disease can also qualify.
Medicaid, on the other hand, is based on income. It provides healthcare coverage for low-income individuals and families, pregnant women, and those with disabilities.
4. Is Medicare Free?
The short answer is no, Medicare is not entirely free.
However, for most people, Medicare Part A usually has a $0 premium. Typically, if you or your spouse has worked for at least 10 years and paid Medicare taxes, you won't have to pay a premium for Part A coverage.
It's important to note that there may still be other out-of-pocket costs associated with Part A, such as deductibles, copayments, and coinsurance. The coinsurance on these plans can be substantial in some cases, which is why many people decide to pay for a Medicare Supplement plan on top of that.
Other parts of Medicare, such as Part B (medical insurance) and Part D (prescription drug coverage), require monthly premiums. They also have deductibles, copayments, and coinsurance. The specific premium amount you'll pay can vary based on your income and the type of coverage you choose.
The premiums are adjusted by the government every year, so it's a good idea to stay updated on any changes or consult with a Medicare representative to get the most accurate information regarding the specific cost of Part B premiums based on your individual circumstances.
5. Why Isn't Medicare Free Since I've Been Paying Medicare Taxes My Entire Life?
While you might have been paying Medicare taxes for your entire working life, the taxes that have been paid into the program are not enough to cover the cost of everything.
Your taxes mainly go into making Medicare Part A available at a $0 premium so other parts of Medicare require additional funding to provide comprehensive healthcare benefits.
Medicare Part B, for example, is partially funded through the premiums you pay. You can read more about Medicare funding on Medicare’s website.
6. Can I Just Enroll in the Same Plans My Friend Has?
No, you shouldn't sign up for a Medicare plan just because someone you know has it. While your friend's plan may work well for them, it may not necessarily meet your own unique needs.
This is especially true for Medicare Part D, which covers prescription drugs. If you and your friend take different prescriptions, it's important to ensure that your plan covers the medications you need at the lowest out-of-pocket cost possible.
It's also important to remember that your friend's risk tolerance may be different from yours.
If you and your friend have a different health background, you may be at different risk levels for needing medical care. A healthy friend with a low risk for any health issues may be better off with a lower premium Medicare Advantage plan that will have higher out-of-pocket costs if something happens.
Whereas if you have a different health background or any underlying health issues like diabetes or a heart problem, you will anticipate needing more medical care and would want to make sure you are properly covered for that.
In that case, a Medicare Supplement plan may be your best fit, as it has a higher monthly premium, but little to no out-of-pocket costs.
So rather than enrolling in the same plans as your friend, consult with a licensed sales agent at Sams Hockaday, and we can run a plan comparison for you. We’ll make sure you pay the lowest out-of-pocket cost for the specific prescriptions that you take, and we’ll ensure that the plan suits all your future medical needs.
7. What's the Difference Between Medicare Supplements and Medigap?
Medicare Supplements and Medigap are the same thing. These terms are just two different ways to describe health plans that are designed to fill in the coverage gap that is left by Medicare Parts A and B.
While Medicare Parts A and B offer comprehensive health coverage, there are still many expenses you are responsible for paying out-of-pocket like deductibles, copayments, and a coinsurance.
Medicare Supplement insurance policies, or Medigap plans, are designed to help pay for some or all of those out-of-pocket costs. These policies are sold by private insurance companies and are regulated by both federal and state laws to ensure that they meet certain standards of coverage.
8. I Turn 65 Soon… What Do I Need to Do?
If you're turning 65 soon, it's time to start looking at Medicare plan options! You have a seven-month window to sign up for Medicare, which includes the three months before your birthday month, your birthday month, and the three months after.
If you miss this window, you may have to pay a penalty fee and could experience gaps in your health coverage.
Considering the multitude of plan options, including Medicare Supplement and Medicare Advantage plans, rather than navigating everything on your own, you can reach out to us at Sams Hockaday.
We prioritize education and ensure you have a clear understanding of all your options. While the ultimate decision is yours, we're here to provide guidance throughout the entire process.
We recommend reaching out at least 3-6 months before your 65th birthday so we can make sure you meet all the necessary deadlines.
9. I Want Nothing to Do with Medicare. What Happens Then?
If you qualify for Medicare but don't want to enroll, it's completely up to you.
However, if you decide to hold off on signing up when you first become eligible and don't have other credible coverage, you will start racking up penalties for each month you go without Medicare that you'll have to pay if and when you eventually enroll in Medicare.
Additionally, if you don't enroll in Medicare and don't have another credible insurance coverage, you could be responsible for paying the full cost of your medical expenses out of pocket.
So, take some time to carefully consider your options before making a decision about enrolling in Medicare.
10. Are the Commercials about Free Medicare Plans, Dental Exams, and Pre-loaded Debit Cards Legit?
You may have seen commercials promoting free Medicare plans, dental exams, and pre-loaded debit cards. Most of these commercials are about Medicare Advantage plans. While some of these claims may be technically true, they can be misleading.
Usually, they are referring to the fact that the plan has a $0 premium which leads you to believe they will be free, but in reality, you will have a lot of out-of-pocket costs like deductibles and coinsurance.
While many of these Medicare Advantage plans do offer great perks like no-cost dental exams, hearing exams, vision exams, and sometimes even pre-loaded debit cards with an allowance for over-the-counter medications, you should never buy a plan based solely on these perks.
You want to make sure the health coverage offered by the plan is what best suits your medical needs and that the deductible and possible out-of-pocket costs are something you can financially handle.
It's also important to be aware that some of the benefits offered in the commercials are only available in certain locations which may or may not be where you are located.
Note: CMS has created a new compliance regulation that doesn't allow anyone to advertise a plan in an area where it's not available. This goes into effect on September 30, 2023.
If you have questions about something you see in a commercial, call an agent at Sams/Hockaday. We will be happy to verify whether the benefits advertised in the commercial are available in your area and help you choose a plan that best suits your needs.
11. Is Medicare Here to Stay or Is It Going to Go Under Like I Keep Seeing in the News?
Each year, Medicare puts out a Trustees Report detailing its spending and financial situation, and in recent years they have stated that Medicare will soon become insolvent. However, you may want to take this information with a grain of salt.
This has been their prediction for many years, and Congress has always stepped in to make sure that this doesn't happen.
So, while there's always the possibility that major changes could be made in the future, we believe that Medicare will continue to be an important part of our healthcare system for the foreseeable future.
12. Why Does My Doctor Wince When They Find Out I Have a Medicare Advantage Plan?
It's not just your imagination – many doctors, especially specialists, dislike Medicare Advantage Plans. These are managed care plans, and they give insurance companies the power to dictate treatments and medications.
Many insurance companies will require you to try a less expensive prescription or treatment option before they will approve a more costly option.
This can be incredibly frustrating for doctors who just want to provide the best care for their patients without being constrained by an insurance company's limitations. You can read a real example of this in this article.
Original Medicare, on the other hand, is a fee-for-service plan that offers greater flexibility. You can typically choose how you want to be treated, and Medicare will pay for it, which is why many patients and doctors prefer that type of plan.
Don’t be afraid to ask questions! Medicare is complex, and no one expects you to have all the answers on your own.
At Sams/Hockaday, we're here to answer your questions and guide you through the Medicare process. We make Medicare easy.
Schedule an appointment with us today to get the information and guidance you need!