Sort through the confusion and better understand your Medicare options with answers to these important questions.
byNov 7, 2016
Content provided by the American Grandparents Association.
The ins and outs of Medicare are confusing. And even when you've got the basics down, there are still specific questions you need answered. Here is a list of common questions and the answers you're looking for. To learn about Medicare Basics, get our AGA Guide to Understanding Medicare.
Q: When can I enroll in Medicare?
A: You can sign up for Medicare Part A and/or Part B during a seven month window that includes the three months before the month you turn 65, the month of your birthday, and the three months after you turn 65. If you are receiving Social Security, you will automatically be signed up for Medicare Parts A and B starting the first day of the month you turn 65.
Q: Do I have to be on the same plan(s) as my spouse?
A: No. All Medicare plans are issued on an individual basis.
Q: Does Medicare cover long-term care?
A: Most long-term care isn’t medical care, but rather help with basic personal tasks of every- day life, sometimes called “activities of daily living” or “custodial care.” Medicare does not cover long-term care, if that’s the only care you need.
Medicare does cover:
Q: Does Medicare cover nursing homes?
A: Medicare Part A only covers skilled care given in a certified nursing facility for individuals who meet certain conditions. To learn more, visit www.medicare.gov and search “Medi- care Coverage of Skilled Nursing Care.”
Q: Why would someone opt to buy a Medicare Advantage Plan over getting Medicare Part A and Medicare Part B?
A: When it comes to Medicare, the decision is yours. However, you may want to get a Medicare Advantage Plan instead of Original Medicare if:
Q: What factors make a difference when deciding between a Medicare Advantage (Part C) HMO and PPO?
A: Medicare Advantage Health Maintenance Organization (HMO) plans allow you to choose from a network of contracted doctors. You’ll choose a primary care physician from the plan network and be referred to specialists within the plan network if you need additional care.
Many retirees and seniors seek out HMO coverage because of the cost savings.
Medicare Advantage Preferred Provider Organizations (PPO) plans offer care within a network of physicians and hospitals. Unlike with an HMO plan, you can also see providers outside of the network of physicians and hospitals, but you’ll pay more out of pocket.
Q: How do Prescription Drug Plans (Medicare Part D) differ?
A: Each Part D plan has its own formulary, or list of covered generic and brand-name drugs.
All plans must cover certain categories of drugs, but the drugs covered in each category may differ by carrier. Part D Plans also set their own monthly premiums, so the costs may also differ by carrier.
Q: How do I know whether or not it’s better to get a Medicare Advantage Plan, or Original Medicare with a Medicare Supplement Plan?
A: Everyone’s healthcare needs are different. To find the right plan for you, it’s best to reach out to licensed plan representatives for more information.
Q: How do Medicare Supplement/Medigap plans differ from each other? Is it in price only?
A: Medicare Supplement/Medigap plans (Letters A-N) offer different levels of coverage, but each lettered plan includes the same coverage regardless of carrier and location. What differs is the price based on the carrier. Some Medicare Supplement Plans also offer cov- erage for services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S.
Q: Where can I find out more information?