Several persons would not be able to access basic health care if Medicare benefits were to be eliminated. It can be costly and stressful not to understand the intricacies of your health care coverage.
Medicare is a federal health insurance program. It is aimed to provide and minimize the cost of medical care for those who are Medicare eligible. A Medicare beneficiary must be
- Eligible for benefits under Medicare Part A and is enrolled in Medicare Part B
- Signed up for both Medicare Part A and B
- Resident in the United States.
How to be Eligible for Medicare Enrollment
The same requirement is needed for Medicare enrollment all over the United States. The requirements for Medicare in Texas are the same as that in New York. To be qualified for Medicare benefits in Texas, NY, or the U.S. in general, you must:
- Be aged sixty-five or older.
- Be less than sixty-five years of age with eligible disabilities by the Social Security Administration.
- Have End-Stage Renal Disease (ESRD)
- Have Amyotrophic Lateral Sclerosis (ALS).
Things Every New Medicare Beneficiary Should Know
- You Must Know The Medicare Parts
As a Medicare beneficiary, you must know the different parts of Medicare. There are four parts which will be explained below. They each offer different levels of coverage, and you can decide what best suits your needs.
- Part A
Part A of Medicare covers your care within the hospitals, critical access hospitals, and skilled nursing facilities. It also contributes to the cost of hospice care as well as some in-home care. To qualify for these benefits, there are requirements clapped. There would be no Medicare Part A charges if you paid adequate Medicare taxes while working.
- Part B
Medicare part B covers doctors’ services, as well as other healthcare providers. Medicare benefits for Part B include;
- Outpatient treatment
- Home health care services
- Durable Medical equipment
- Numerous preventive services.
- Part C
Plan C is also known as the Medicare advantage plan. Individuals who qualify for Medicare Parts A and B are also eligible for this plan. Customers purchase Medicare Advantage plans from private insurers rather than the government. Medicare Advantage plans must provide coverage that is at least comparable to Original Medicare.
Rather than enrolling in original Medicare, some individuals choose to sign up for a Medicare Advantage plan provided by a private insurance company. Medicare Advantage plans frequently have lower premiums than traditional Medicare. A Medicare Advantage plan’s network, on the other hand, is generally tighter.
You may require prior approval or a referral to see a specialist. Prescriptions are included in Medicare Advantage plans rather than having to purchase separate drug coverage as with original Medicare.
- Part D
Medicare Part D provides supplemental prescription drug coverage. Original Medicare (Part A and B) beneficiaries may enroll in Part D to get the prescription drug cost subsidies that Original Medicare plans do not cover.
- Know The Enrollment Period
If you do not enroll in a Medicare program during your initial enrollment period, you may be charged a higher monthly fee if you do so later. The exception is if you have reached the age of 65 and continue to have coverage through your or your spouse’s employer. Or if you have better prescription coverage at the time of eligibility.
There are seven months in which you can sign up for the Medicare program for the first time. The enrollment period begins three months before and ends three months after your 65th birthday. During these seven months, you can enroll in any Medicare coverage you want.
- Understand Basic Medicare Terminology
Learning Medicare terminology is one of the most important things that any new Medicare Beneficiary should do. Understanding the meaning of terms will go a long way. Knowing the right terms will assist you in navigating your Medicare coverage. Visit the Medicare website or your local library and ask the reference librarian for assistance and additional information.
- Understand How to Change Your Medicare Plan
After you’ve entered a plan during your first enrollment period, you’ll be able to change plans once a year during the open enrollment period. This is available from October 15th to December 7th. You can also swap from your original Medicare to a Medicare Advantage plan at this time. Furthermore, you can join, switch, or drop your Medicare drug plan.
- High Earners Pay More for Medicare
Parts B and D will cost you more if your income exceeds a certain level. These surcharges are calculated using your adjusted gross income from two years ago.
- Medicare Provides More Free Preventive Services
A variety of preventative health services are available to Medicare beneficiaries. You are entitled to a free “wellness” visit once a year to advance or upgrade a personalized prevention plan. Every five years, beneficiaries are also given a free cardiovascular screening. Furthermore, you are entitled to annual mammograms, flu shots, and cervical, prostate, and colorectal cancer screenings.
- You Can File an Appeal Against a Medicare Decision
If you disagree with a Medicare health plan coverage or payment decision, you can file an appeal. The appeals process is divided into five levels. You can move up a level if your appeal is denied at a lower level. To proceed, you can obtain any relevant information from your doctor, health care provider, or supplier.
- Medicare Offers Telehealth Services
Telehealth services are basically the use of telecommunication to connect doctors and patients, you can consult a doctor without in-person clinic visits.
For many years, many Medicare Advantage plans have included telehealth coverage. Traditional Medicare, on the other hand, is used to limit the service to specific devices and practitioners. Patients had to be in a Medicare facility. Fortunately, telehealth was expanded when the coronavirus pandemic struck.
Patients could consult with a broader range of medical professionals from the comfort of their own homes using smartphones. This could be a permanent feature. But then, before using telehealth services, you should check with your plan’s provider. This is to ensure that a specific service is supported and to get a calculation of any out-of-pocket costs.
Conclusion
The federal government of the United States initiated Medicare to provide subsidized health care services for those above 65. Also, Medicare is for those with certain disabilities.
As one who is eligible for Medicare benefits, you must be well informed about the program. Understand the different parts of Medicare and know the one to enroll in per time.
