Frequently Asked Questions about Medicare Plans, Insurance and Prescription Drug Coverage
What Does Medicare Cover?
Medicare has four parts, but only two parts that we need to consider for now. Those two parts are Medicare Part A and Medicare Part B.
Medicare Part A covers hospitalization, nursing home stays, home health services, and hospice care among other things.
Medicare Part B covers preventive care, doctor visits, outpatient services, durable medical equipment, and care services for non-preventive care issues like emergency room treatment or emergency surgery.
Why Do I Need to Supplement Medicare?
Medicare Part A coverage requires you to pay $1,364 for Medicare health care per benefit period in 2019. That amount has been increasing annually.
There is no limit to how many times you may have to cover the deductible.
A benefit period ends when you have not received hospital or skilled nursing facility care for 60 consecutive days. The next time you need Part A coverage, you have to meet the Part A deductible again.
Once you’ve met the deductible, you may still have to endure cost-sharing. If you need hospital care for between 61 and 90 days, you are charged $341 per day in 2019. If you need more care, you pay $682 per day for up to 60 days to be used over your lifetime. Once that’s exhausted, Medicare no longer covers inpatient hospital bills.
Medicare Part B covers other expenses like doctor bills, medical supplies and outpatient services. You need to meet an annual deductible before Part B coverage begins. In 2019, that deductible is $185. Part B coverage leaves you to pay for 20 percent or more of most health care costs.
Recommended preventive services are 100 percent covered. For other services, Medicare pays 80 percent of a pre-determined rate. In addition to your 20 percent share of costs, doctors may charge you for the difference between what Medicare pays and what they charge.
If you travel outside of the United States, Medicare only rarely covers emergency medical care. Medigap plans offer that travel insurance.
With only Medicare, you can’t limit your annual out-of-pocket costs for health care. You can, however, be assured a definite limit with a Medigap plan or a Medicare Advantage plan. These plans let you know for sure what is the most you will have to spend in a given year.
Request a confidential consultation or call us at 1-800-913-3416 to see what plans are available where you live. There’s no charge or obligation to buy when you talk with us.
How Does Medicare Work With My Group Health Insurance Coverage?
You may already have health insurance coverage through a group policy provided by your employer. If you are still working at age 65 or will be 65 in three months or less, you are eligible for Medicare.
You can be covered by your group policy and Medicare at the same time, but it isn’t as simple as having two sources of health coverage. The type of policy you have determines when Medicare starts covering costs.
You can find Medicare coordination of benefits information and scenarios in the Medicare.gov Guide to Who Pays First.
You may be enrolled in a small group policy or a large group policy.
Small group policy:
- Covers 20 employees or less
- Medicare pays first
- Policy pays second
Large group policy:
- Covers 50 employees or more
- Policy pays first
- Medicare pays second
You may be wondering if you need to keep both policies. If you have small group coverage, Medicare pays first, so enrolling in Medicare as soon as you are eligible is a smart strategy.
If you have a large group policy, your policy pays first, so you will need to look at the numbers and compare the cost of your current group plan to the cost of Medicare. Medicare premiums are typically lower.
However, it’s not just the premiums you need to consider. Medicare does not pay for everything. Your group policy may offer more comprehensive coverage. Also, unless your spouse is eligible for Medicare, opting out of your group plan may mean your spouse is left without health insurance. If that is the case, you may need to consider a COBRA plan, which can be very costly.
We can help answer your questions about how Medicare works with your group coverage. Please call us at 1-800-323-1441. We can also connect you with a Personal Benefits Manager for a free consultation. There’s no obligation, and no high-pressure sales tactics when you to speak with us.
How Can I Expand My Medicare Benefits?
You can add a Medigap plan to pay Medicare copayments, deductibles and excess charges. There are 10 Medigap plans with standardized benefits available in most states, so you have a choice of which out-of-pocket costs to avoid. Medigap Plan F offers the most-comprehensive protection.
Since Medicare rarely covers prescriptions, including insulin (unless you use a pump), you may want to add a Part D prescription drug plan to supplement your Medicare. The standard Part D deductible in 2019 is $415.
An alternative is to switch from Original Medicare to a Medicare Advantage plan. An Advantage plan takes the place of Medicare, although it provides the same coverage as Medicare Parts A and B. Medicare Advantage plans also typically include prescription drug coverage. Unlike Medicare, Advantage plans usually also help with dental, eyeglasses and hearing aids. These policies can be divided into categories. Some plans operate like HMO or PPO health plans; there are other options available as well.
Medicare Advantage and Part D plan benefits vary. Request a confidential consultation or call us at 1-800-913-3416 and we will research what plans are available where you live and help you compare them.
If you know you want a Medigap plan, please contact us at 1-800-913-3416 to request an application, or get an online quote.
What If I Have Pre-Existing Health Problems?
When you enroll in Medicare, you have a six-month open enrollment period to apply for a Medigap plan without answering any questions about your health. In certain other circumstances, you may also be entitled to open enrollment. Give us a call at 1-800-913-3416 to be sure.