Some Of The Most Common Medicare Questions Answered

By Brian Turner


As people near retirement age, they start to think about what to do next. Most understand that they will begin to receive Social Security checks to supplement their income, or as their only income. Most seniors know something about the medical benefits they have earned and will receive when they reach sixty-five. The particulars of these benefits are sometimes confusing however. To make responsible, informed decisions about their health, older Americans need their Medicare questions answered.

People want know when they are supposed to enroll. There is a seven month window in which you can sign up for benefits. It begins ninety days before you turn sixty-five and lasts ninety days after your sixty-fifth birthday. If you're already getting Social Security, you don't have to enroll. The system will sign you up automatically for both Parts, A and B, on the first of the month you become sixty-five.

Seniors are concerned about long term health care and want to know if their benefits include it. The simplest answer is no. You will not be covered for things like custodial care and help with daily living, if that is the primary focus of your needs.

Medicare does pay for long term hospital care and a portion of nursing care in a facility that meets the program's criteria. Your benefits cover hospice, respite care, and some home health services. For more detailed information regarding nursing home care, check Medicare's website.

Seniors are often confused about why someone chooses the Advantage Plan over Parts A and B. One reason is because Advantage Plans will cover prescriptions, which Parts A and B don't. There is an out-of-pocket cap with an Advantage Plan. Once you have paid sixty-seven hundred dollars during a year, the Advantage Plan pays one hundred percent of covered expenses. If you want dental and vision care covered, you will have to sign up for a Advantage Plan because Medicare won't pay for either.

HMOs and PPOs are another source of confusion. Many seniors are unsure what the difference is between these two. Health Maintenance Organization plans, or HMOs, cost less when it come to the money that comes out of your pocket. That's what makes them attractive to many seniors. You must use a physician in their network though. Many HMOs cover prescription drugs.

PPOs, Preferred Provider Organization, plans let you choose any doctor who accepts Medicare. You don't have to stay in their network, which is a big draw for seniors who love the doctors they have and don't want to have to make a change. You will pay more for monthly premiums with these plans. If you go outside the network for a doctor, it may cost more than if you had chosen a doctor in their network. These plans can cover prescription drugs.

The difference between Medigap and supplemental insurance is another area of confusion. The main difference is in the carrier you use. All the lettered plans are just the same. It doesn't matter where you live or which carrier you use. The price can vary from carrier to carrier.




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