MEDICARE BASICS: ANSWERS TO COMMON QUESTIONS

What’s the difference between Medicare and Medicaid? Medicare and Medicaid (in California, Medi-Cal) are two separate programs with distinct differences. Medicare is a federally run insurance program that serves people primarily over the age of 65, regardless of income. Most people become eligible for Medicare at age 65. The first time you can sign up is during your Initial Enrollment Period, which lasts for a total of seven months. It includes the month you turn 65, and the three months before and after. For the most part, Medicare is the same throughout the United States.

Medicaid is a joint federal and state program that helps pay medical costs for families and individuals — regardless of age — who have limited income and resources. To be eligible for Medicaid, you must meet certain requirements. Some people qualify for both Medicare and Medicaid.

^{Source: “Medicare & You 2018,” Centers for Medicare & Medicaid Services, accessed at Medicare.gov}

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What are my options for Medicare coverage? There are two ways to get your Medicare coverage. You can go with Original Medicare, which is Part A and Part B. Or, you can opt out of Original Medicare and go with Part C, also known as Medicare Advantage.

• Original Medicare (Parts A and B) — Part A is your hospital insurance. It provides benefits for hospitalization, skilled nursing, hospice and home health care. Most people don’t pay for Part A since it’s usually covered by the taxes you paid when you worked. Part B is your medical coverage. It helps pay for things like doctor visits, outpatient procedures and emergency room services. There is a monthly premium for Part B, and that usually comes out of your Social Security check. That amount can change each year.

• Part C (Medicare Advantage) — Medicare Advantage replaces Original Medicare. That means if you go with a Medicare Advantage plan, you opt out of Original Medicare — so you won’t have Parts A and B. Medicare Advantage plans are offered by Medicare-approved private insurance companies. They normally cover Parts A and B, and sometimes include a prescription drug plan. Medicare Advantage plans, as well as their networks and providers, can change from year to year. It’s also possible that a Medicare Advantage plan can be discontinued.

Before you select one Medicare option over the other, make sure you understand the differences so you can make the best choice for you.

^{Source: “Medicare & You 2018,” Centers for Medicare & Medicaid Services, accessed at Medicare.gov}

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What is Medicare Part D? Part D is Medicare’s prescription drug coverage and is available for a monthly premium. It, too, is provided by private insurance companies that work with Medicare. Generally, you’ll want to sign up for Part D at the same time you sign up for Original Medicare — even if you’re not on medications at the time you retire. That way, if you need medications down the road, you’ll avoid a late enrollment penalty by having your coverage already in place.

There are a variety of Part D prescription drug plans to choose from. They differ in how much they pay, depending on the drugs and pharmacies you use. The costs for these plans and the list of drugs they cover can change each year. Plus, the prescriptions you take may change. If your plan no longer fits your needs, you can switch to a different Medicare private drug plan during Medicare’s Open Enrollment Period.

^{Source: “Medicare & You 2018,” Centers for Medicare & Medicaid Services, accessed at Medicare.gov}

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If I have Original Medicare and Part D, is that all I need? Medicare is a great program, but it was never intended to pay all of your medical expenses. There are deductibles and co-pays, and those can go up each year.

To help cover these costs, many people get Medicare Supplement insurance — also called Medigap. This type of coverage is available through private insurance companies. There are several standardized Medicare Supplement insurance options, and the benefits you get depend on the option you choose.

With Medicare Supplement insurance, you have a six-month Open Enrollment Period when you’re guaranteed coverage, no matter what. That period lasts six months and begins the first day of the month in which you are 65 or older and enrolled in Medicare Part B. It’s important to know when your Open Enrollment Period is. If you miss it and want to get coverage later on, you may have to answer health questions. You might even lose your chance to get a Medicare Supplement insurance policy at all. You can only get Medicare Supplement insurance if you have Original Medicare, Parts A and B.

^{Source: “Medicare & You 2018,” Centers for Medicare & Medicaid Services, accessed at Medicare.gov}

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What is Medicare Open Enrollment? Medicare Open Enrollment is the time each year when people already enrolled in Medicare can make changes to their coverage. It runs from October 15^th through December 7^th. People are often confused about what they should or shouldn’t do during Medicare’s Open Enrollment. Here are a few tips to help you better understand Open Enrollment:

• If you have Original Medicare along with a Medicare Supplement insurance policy, and you’re happy with your coverage, you don’t need to do anything.

• If you have a Medicare Advantage plan (Part C), Open Enrollment is the time to review your plan for the coming year. That’s because Medicare Advantage plan benefits can change from year to year. Before Open Enrollment begins, you should receive an Annual Notice of Change. Your Annual Notice will detail any changes in your plan’s costs, benefits, provider network and other rules for the upcoming year. If your Medicare Advantage plan no longer fits your needs, you can change plans — or switch back to Original Medicare (Parts A and B) — during Open Enrollment.

• If you have Part D, Medicare’s prescription drug plan, Open Enrollment is also the time to review your coverage since plan benefits can change each year. You should receive an Annual Notice of Change from your plan’s administrator before Open Enrollment begins. You’ll want to review your plan to make sure it continues to meet your needs in the year ahead.

^{Source: “Medicare & You 2018,” Centers for Medicare & Medicaid Services, accessed at Medicare.gov}

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