Medicare is no doubt a godsend to seniors 65 years and older and younger people living with qualified illnesses or disabilities. Nonetheless, it can be a source of confusion for potential and new beneficiaries, leaving them with a lot of questions about its services and requirements.
Whether you are new to Medicare or a potential beneficiary, here are the answers to some of the most frequently asked questions about its services to get you started.
Q: What Does the Medicare Alphabet Mean?
Medicare Parts A, B, C, and D refer to the four different types of coverage available to beneficiaries. Here’s an overview of each part:
- Part A- This provides coverage for hospitalizations, hospice care, and some skilled nursing care (this is the type of care you receive after you get hospitalized for a hip fracture, stroke, or other conditions that require rehabilitation in a nursing home or similar facility).
Most people— specifically those ages 65 years or older and who or whose spouse worked and paid Medicare taxes for a minimum of 10 years— don’t need to pay a premium for Medicare Part A. If you don’t belong to this category, you will likely have to pay hospital inpatient deductible ($1,556 for 2022) for each benefit period.
- Part B- This provides coverage for outpatient medical services, including lab tests, doctor visits, medical equipment, diagnostic tests, and ambulance transportation.
The standard monthly premium for Medicare Part B is $170.10 for 2022, or higher if your income is more than $91,000.
- Part C- Also known as Medicare Advantage, Part C is like a one-stop shopping choice combining all the other Medicare parts into one plan.
The premium that you pay for Part C will depend on what type of plan you choose: either health maintenance organization (HMO) or preferred provider organization (PPO).
- Part D- This provides coverage for a wide range of prescription drugs, including those used for the treatment of HIV/AIDs and cancer.
Monthly premium for Part D also varies by plan.
Q: What if I Work Past the Age of 65 and Have Healthcare Insurance Through my Employer?
In that case, you may be able to delay Medicare enrollment or enroll during your Initial Enrollment Period (IEP) in Parts A, B, and D to avoid late penalties, depending on your employment and if your employer’s coverage is creditable. If you delay Medicare, you can still enroll in just Part A at 65 in addition to your employer coverage.
Q: Is Medicare Mandatory?
No, but if you decide to enroll in any part of Medicare after your IEP, you could incur financial penalties unless you qualify for a Special Enrollment Period with creditable employer coverage.
Q: What Is the Difference Between a Medicare Advantage HMO and PPO?
A Medicare Advantage HMO plan usually helps pay only for the care you receive from medical providers within the plan’s network: you can choose a primary care physician who then will direct your care and give you a referral to see a specialist if you need advanced treatment. A PPO plan, on the other hand, generally helps pay for the care you receive outside the plan network— although it may pay less than what it does for the same care you receive from in-network medical providers.
Q: Do I Have to Renew Medicare Every Year?
No. Medicare coverage automatically renews each year unless you change your plan. However, the plan benefits and costs may still change each year. You can review your Medicare choices annually during the Medicare Annual Enrollment Period each fall, which runs between October 15 and December 7.
Q: How Are Medicare and Medicaid Different?
Although Medicare and Medicaid are both government healthcare programs, they are different: Medicare, as mentioned, is for people who are 65 or older, or who have a qualified disability, while Medicaid is a state-governed program for those with limited income and resources.
Q: How Should I Decide Which Medicare coverage Is Right for Me?
Consider your personal healthcare needs, then choose the Medicare coverage that best helps to meet them. For example, if you are currently taking prescription medications, you will need to make sure you get Part D prescription drug coverage either through a stand-alone Part D plan or a Part C (Medicare Advantage plan), which covers aspects of Part D into a single plan.
For comprehensive information about Medicare services as they relate to your individual healthcare needs, visit Medicare.gov.
Primary Care Practice Serving Medicare Advantage and Medicaid Patients in Florida
At Palm Medical Centers, we are a premier provider group whose foremost goal is to deliver high-quality, comprehensive healthcare resources to the communities we serve. We are proud to accommodate more than 34,000 Medicare Advantage and Medicaid beneficiaries at our 22 clinics throughout Central and South Florida.
Our friendly staff takes pleasure in answering any questions you may have about your Medicare Advantage or Medicaid coverage, or any of our primary care services. Just call or visit our clinic nearest you.