You can get Medicare coverage either through Original Medicare or Medicare Advantage Plans.
You can also purchase a Medicare Supplement (aka: Medigap) plan in addition to Original Medicare. A Medicare Supplement helps cover your portion of the costs that are associated with Medicare-covered services. All doctors and hospitals that accept Medicare also accept Medicare Supplements. If you need help covering your prescription drugs, Medicare Part D is also available for purchase.
Medicare Advantage Plans are called Medicare Part C. These are health plans that are approved by Medicare and administered by private companies. Under a Medicare Advantage Plan, Medicare Parts A & B are covered and usually include a Medicare prescription drug plan. Sometimes these plans include extra benefits like dental, vision, hearing, and gym memberships.
If the services, you need are considered medically necessary then they will be covered. Original Medicare won’t cover things like long term care, routine services like vision or dental care, hearing aids, glasses, or private duty nursing.
There are also out-of-pocket costs like coinsurance, copayments, or deductibles associated with Original Medicare that do not have a cap on their expenses (maximum-out-of-pocket). Considering the two main ways that you get your Medicare coverage is very important, whether it’s with a Medicare Supplement Insurance Plan and Medicare Part D or a Medicare Advantage Plan.
All Medicare Prescription Drug Plans have a formulary. This is a list of covered drugs and must include a variety of drugs in the most common categories. This is to ensure that people with different medical conditions get the treatment they need. Medicare Prescription Drug Plans must, as a rule, cover at least 2 drugs in each category, but a plan can decide which specific drugs they will cover in those categories.
Prescription costs will depend on your specific plan and drugs. Many people pay a monthly premium and a share of the cost of their prescriptions, including copays, coinsurance, and/or a deductible. Medicare sets a standard level of coverage that all Medicare Prescription Drug plans must provide. Some plans may offer additional drugs and more coverage but typically will also have a higher premium.
For those with limited income and resources, extra help may be available. Those with higher annual incomes may have to pay a Part D Income Related Monthly Adjustment Amount (IRMAA).
For those already receiving Social Security benefits, you will be automatically enrolled in Medicare. When you are enrolled, you will receive an Initial Enrollment package that includes your Medicare card and additional information. This packet will come about 3 months before your 65th birthday, or 3 months before your 25th month of disability benefits.
For those not receiving retirement benefits from Social Security or the Railroad Retirement Board, you will have to sign up to get Medicare.
Your Part B enrollment rights can be affected by having coverage through an employer. If you or your spouse are still covered because one of you is actively employed, you will have a Special Enrollment Period.
A Special Enrollment Period means that you can join Part B any time you or your spouse are covered by a group health plan through work, or during the 8-month window that starts the month after your employment or group health plan coverage ends, whichever comes first. Typically, you won’t have to pay a late enrollment penalty when signing up during an SEP. It’s always a good idea to reach out to your employer or union benefits administrator to find out how your health plan works with Medicare and if it’s to your advantage to delay enrolling in Part B.
No. This is something that, in most cases, is against the law because it is considered duplicate coverage. When you have Medicare, you are covered and don’t need to enroll in Marketplace coverage.
If you qualify for Medicare after you sign up for a Marketplace plan, its most likely to your advantage to sign up for a Medicare plan because:
- a) Once you’re become eligible for Medicare, you will not qualify for a income based subsidy for a Marketplace plan.
- b) If you wait to enroll in Medicare after your Initial Enrollment Period, you could potentially have to pay a penalty for late enrollment if you have Medicare.
Medicare Part A does not normally have a monthly premium if you or your spouse paid Medicare taxes while you were working. Part B does have a premium each month. In 2021, most people will pay $148.50, which is the standard Part B premium.
From Medicare.gov: If your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, you'll pay the standard premium amount and an Income Related Monthly Adjustment Amount (IRMAA). IRMAA is an extra charge added to your premium. https://www.medicare.gov/basics/costs/medicare-costs