Medicare for You: What You Need to Know
Reading Time: 2 MinutesLast Updated: April 6, 2023
We invited the Administrator to share helpful information on Medicare coverage. This is part 1 in the two-part series.
Your health is important and needs to be protected. If you are 65 or older, or have certain disabilities, or End-Stage Renal Disease, you can get health care coverage through the Medicare program. You’ll get access to health care services you need to achieve and maintain good health.
It’s important to review your Medicare coverage options and find an affordable option that meets your health care needs.
Medicare coverage options
There are two types of Medicare coverage:
- Traditional or Original Medicare.
- Medicare Advantage.
Original Medicare helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care. It also covers:
- Services from doctors and other health care providers.
- Outpatient care.
- Durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment).
- Preventive services (like screenings, certain vaccines, and annual wellness visits).
Original Medicare is often referred to as Part A and Part B. You can go to any doctor or hospital, anywhere in the United States, that accepts Medicare. If you have Original Medicare, you can also buy a Medicare Supplement Insurance (Medigap) policy from a private insurance company. Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. A Medigap policy can help pay some of the remaining health care costs, such as copayments, coinsurance, and deductibles.
Medicare Advantage bundles your Original Medicare – and usually Medicare prescription drug coverage – into one health insurance plan. If you select Medicare Advantage coverage, you join a plan offered by Medicare-approved private companies.
Each plan can have different rules for how you get services – like referrals to see a specialist. All plans must cover emergency and urgent care, as well as all medically necessary services covered by Original Medicare.
In many cases, you can only use doctors and other providers who are in your plan’s network and service area. Costs for monthly premiums and services vary depending on which plan you join. Some plans may offer some extra benefits that Original Medicare doesn’t cover — like vision, hearing, and dental services.
Whether you choose Original Medicare or Medicare Advantage, be sure you have prescription drug coverage. You can join a Medicare Prescription Drug Plan (called a PDP) in addition to Original Medicare. You can also get it by joining a Medicare Advantage plan with Medicare prescription drug coverage.
Please visit Medicare.gov to learn more about the difference between Original Medicare and Medicare Advantage. With the Medicare Plan Finder, you can see comparisons of costs and coverage for Original Medicare, Medicare Advantage, and Medicare drug plans.
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Tags: General Information, Medicare
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Jeff H.
I am currently retired and turning 65 in September 2023. My last employer is obligated by contract to fund a medical insurance policy for me until 9 months after I turn 65. The policy covers all medical/hospital expenses.
Would this policy be considered “credible coverage”? If so, can I defer enrolling in Medicare Part B until June ’24 without a penalty? And if so, should I enroll in Medicare Part A now? Thanks
A.C.
Hi, Jeff. Thanks for your question. Under certain conditions, you may qualify for a Special Enrollment Period, which would allow you to sign up for Medicare Part B when you are past your Initial Enrollment Period. If you are still working and covered under a group health plan based on that employment, you may not need to file for Medicare part B until you stop working or drop your health care coverage. Keep in mind COBRA and retiree health coverage don’t count as current employer coverage. For more information, please visit here.
For specific questions about your case, call 1-800-772-1213, Monday-Friday between 8:00 a.m. and 7:00 p.m. and ask a representative to assist you, or you can contact your local office. We hope this helps.
MARGUERITE J.
i always had Medicaid since age 5 then SSI 85 in 2013 I had to take survivors benefits and had regular MEDICAIRE i already have all Medicare advantage is trying to push on me. the only thing i don’t have is the card for the food. mi can’t get out with all my conditions and diseases i always have to eat fresh vegables and fresh fruit. that’s decimation leaving many of us elders starving is that what you do to those who really need what only what we can eat. this Country has gone to the TAR PIT BECAUSE OF THE CORRUPT POLITITIONS WHO AREN’T FOR THE PEOPLE AND ARE GETTING AWAY WITH IT
Cindy D.
I would like to know why my application for social security and Medicare has taken over 4 weeks with nothing in the mail.
I can call and be on hold for over an hour or go to an office and be told I don’t have an appointment and come back.
If there is a problem I read soc sec would contact me in writing but nothing has come.
I need my Medicare number to obtain gap coverage!!!
A.C.
Hi, Cindy. We are sorry to hear about your experience. For your security, we do not have access to private information in this venue. We encourage you to continue to work with your local Social Security office. You can ask to speak to a manager on your next call or visit. You can also submit feedback by visiting our Contact Social Security page. Once there, select the “Email Us” link. This will take you to the “Email A Question to our Support Team” form where you can complete and submit a compliment, complaint, or suggestion. We hope this is resolved soon.
AJN
Can your Medicaid provider, if you have it, really assume your Medicare coverage, too, becoming a Medicare Advantage plan, taking over Medicare Part D too? Do they need my permission to do that, or just yours?
Edith T.
I don’t think it’s fair for people who are disabled to be cut off SSI because of their spouse’s income when they are disabled too. The income limit is ridiculous and makes it hard when you have to pay all these copayments. Seniors are being penalized for being elderly.
Richard A.
income last year had me and wife paying 230.80 for part b. This year my income dropped considerably. When and if does the rate drop to the current rate.
A.C.
Hi, Richard. Thank you for visiting our blog. Unfortunately, your comment is a bit more complex than we can handle in this forum. For your security, we do not have access to information about your account in this venue. We ask that members in our Blog community work with our offices with specific questions. You can call us at 1-800-772-1213, Monday through Friday, between 8:00 a.m. and 7:00 p.m., for assistance. You can also contact your local Social Security office. We hope this helps.
Gary P.
I just turned 65 today. I signed up for Medicare part A only as I am employed by a very large company (one of the largest employers in the nation, if not the largest) and I have what I am told is “credible coverage” on my group health insurance plan! I have read that if I have credible coverage, and I remain employed and insured on their group plan, that part A is all I am required to take out at this time. BUT then I have A LOT OF PEOPLE telling me that when I do retire when I reach full retirement age of 66 years 8 months, that I will be penalized because I should have added part B! It should not be so difficult to find out the truth in writing, that will prove I will not be surprised with a penalty when I retire from my company and start drawing my Social Security! I read that I will have eight months to get the part B coverage and whatever else required at that time when I retire from my company and am then no longer on their health plan! But people say I’m going to be surprised with penalties!
A.C.
Hi, Gary. Thanks for your question. Generally, people who are covered under a group health plan from either their own or a family member’s current employment have a special enrollment period (SEP) and premium rights. For more information about an SEP, please visit here. For specific questions, you can call us at 1-800-772-1213, Monday through Friday, between 8:00 a.m. and 7:00 p.m., for assistance. You can also contact your local Social Security office. We hope this helps.
Terry A.
How much does outpatient care cost in the US?
cubes 2048
Bob P.
If you only have Original Medicare you pay 20%. If you have a supplement, the most popular being Plan G, after you pay the first $226 you pay the premium and nothing after that. You also need a prescription plan that is an extra premium. Then the prescriptions depend on the plan you pick and which period or stage you are in the Deductible Period, the Initial Coverage Period, the Donut Hole/Coverage Gap, and Catastrophic Coverage Period.
Wayne S.
why am I getting things denied and seem to be paying more with an advantage plan. What should I do to check this out and pursue?
Wayne S.
why am I getting things denied and seem to be paying more with an advantage plan. What should I do to check this out and pursue?
Reply
Sue S.
Medicare Advantage programs can have a large yearly deductible in exchange for its low premium. My husband has a no premium plan, but a yearly $6,000 deductible which is OK as long as you don’t have many health problems.
A.C.
Hi, Wayne. Thanks for visiting our blog. You may wish to contact your local Medicare SHIP (State Health Insurance Program Coordinator) to discuss your concerns. We hope this helps.
Susan O.
I would like to see an article from Social Security about what to do if you are involuntarily enrolled in a Medicare “Advantage” program without your specific consent or prior knowledge, as I am aware is happening across the country.
Also, I would like to see more education from Social Security regarding the fact that a “Medicare Advantage Plan” is NOT Medicare but is, in fact private insurance and may have restrictions that traditional Medicare does not.
Thank you.
Sue S.
Agree.. how can a switch like that happen?
Also agree wit the 2nd point. There is alot of what I think misleading advertising making people think the are missing out on Medicare benefits if they are not in an Anvantage program. That is not correct!
Beth W.
Sue and Susan- You are both correct! There is a lot of predatory marketing aimed at Medciare beneficiaries. Medicare has enacted many new rules recently aimed at curtailing this, but the problem persists. My recommendation is to speak to a local, licensed broker that you trust and can sit face to face with. They will know about all of the plans in your area and should present them in an unbiased way, sharing with you the pros and cons of any decision you make. There is no charge for this professional guidance, but these agents are paid commission by the company you choose. They should be very transparent about this. The best way to be protected from the predators is to not answer any call or text from someone you don’t know and definitely don’t call a toll free number promoted by an athlete or celebrity! These seem to be where most of the complaints come from. You can find a reputable broker in your area at NABIP.com.