What is Medicare? Is it the same as Medicaid? When am I eligible to enroll? Do I still need health insurance? Will I ever be able to quit working to guarantee I have coverage? Where do I even begin trying to figure this Medicare puzzle out?
These are questions asked every day by the 16 percent of the U.S. population who are 62 years or older. According to the US Census Bureau, by 2030 there will be over 73 million older adults who will rely on Medicare for their health coverage. Maybe you have aging parents and you had to learn to navigate the Medicare system quickly out of necessity. Or maybe you are nearing retirement and know that the daunting task of establishing Medicare coverage is looming in your future. No matter what your relationship with Medicare is, having a trusted health insurance partner who understands the complexity of the Medicare system can be an invaluable part of your retirement team.
What is the difference between Medicare and Medicaid?
Many people are confused by the differences between Medicare and Medicaid. That is understandable, but it is important to know there are certain critical distinctions between these two government healthcare programs. Medicaid is a government-subsidized health care program funded by both the federal and state government. Medicaid can also be accessed through private insurance companies. It is similar to group health insurance in the way it handles health benefits. Medicaid is not age dependent and any eligible individual can apply. Medicaid offers health care benefits to low-income adults, pregnant women, children, and disabled individuals. Medicaid covers hospitalization, home health care, doctor’s appointments, outpatient care, x-rays, labs, preventative, and dental care.
Medicare is a federally funded health insurance program for people over 65 or with special circumstances. Medicare and its various parts cover things like hospitalization, skilled nursing, doctor visits, and outpatient care.
The Basics of Medicare
The great Vince Lombardi often reminded his players to get back to basics when he said tongue in cheek, “This, gentlemen, is a football.” We need to start at the beginning and explore the basics of Medicare before we can find peace on the transitional healthcare journey to Medicare. Simply put, Medicare offers many levels of benefits and choosing which plan is right for you can be complicated – which plan covers your medications best, are your doctors in-network? Choosing the right Medicare plan will prevent penalties, reduce taxes, and assure that you have access to the quality healthcare you need as you age. Mike Dietz, owner of MIB Health Insurance says, “If you tell me what your medical needs are, I can tell you exactly what Medicare plan is best for you. Since most of us can’t predict our future medical needs, it is my job to explain benefits and help clients find a plan that allows them peace of mind. No one should lose sleep over Medicare decisions.”
There are multiple plans of Medicare Coverage. You may know them as plans or parts–for example, Original Medicare Part A, B, C, or D. Medicare Parts are simply defined this way. Medicare Part A covers hospitalization and skilled nursing care; Medicare Part B covers outpatient visits, medical equipment, and labs. Medicare Part C is known as the Medicare Advantage Plan. This is most like traditional health insurance combined with Medicare Part A and B, and some times Part D, to provide more complete coverage. Medicare Part D provides pharmacy benefits to cover prescription medication. There are also Medicare Supplement plans (Or Medigap plans) that offer secondary health insurance benefits. These supplement plans are designed to help you cover any gaps from Original Medicare, including your co-pays and out-of-pocket costs. Medicare Part C and D along with supplemental plans are offered by private Insurance companies. We will address the specifics of each of these Medicare plans in a later article in part two of this series. Mike Dietz says, “Determining access to health care is a foundational choice a person must make when starting Medicare. The most important thing is to have freedom of choice if they become sick or need medical care. Finding the best solution for individual clients is the best part of my job.”
What is my Medicare eligibility?
Medicare is a federally funded individual health insurance plan for U.S. Citizens and legal United States residents of five years or more. Those eligible for Medicare will be 65 years and older unless they currently receive Social Security disability benefits or suffer from end-stage renal disease (ERSD). You have a seven-month period of time to sign up for Medicare before and after your 65th birthday. This period is known as an Initial Enrollment Period (IEP).
Some people choose to work after they turn 65 and reach retirement age. If you have a group health insurance plan through your employer, you will still need to decide if you want to, or in some cases, are required to enroll in Medicare. There are complicated rules and time frames for Medicare enrollment. MIB Health Insurance has a proven process to alert you when you are eligible for Medicare and will help you know what is required of you and when.
Medicare Part A is free if you satisfy one of the following:
1) worked at least 40 calendar quarters where you paid Social Security taxes in the US
2) are eligible for railroad retirement benefits or
3) have a spouse that qualifies for premium-free Part A. Individuals receiving Social Security are automatically enrolled in Medicare Part B. If you previously refused Part B or are not drawing Social Security, you can enroll in Part B only during certain enrollment periods. You can enroll for Medicare through the government website, by calling the Social Security office or apply in person at the Social Security office nearest your permanent home.
Medicare does not have to be a scary process. The team at MIB Health Insurance has a proven track record of over 35 years of helping clients understand Medicare eligibility, enrollment, and plan selection process. Their clients trust them to wade through the complexities of Medicare and stay on top of the ever-changing rules and regulations to successfully navigate the transition to Medicare and all the decisions and paperwork that go along with it. Call us today for a free guide to navigating Medicare.
MIB Health Insurance is a family-owned health insurance brokerage with a team of caring health insurance professionals in the Fox Cities who want to understand your unique healthcare story. Together you can find the right Medicare solutions for you and your family. Your health insurance partners at MIB are committed to helping you understand your Medicare options saving you time and money. Call a MIB Health Insurance partner at 920-731-2100 to see what Medicare peace of mind may look like for you.