Medicare’s Basic Facts
Posted on February 28, 2015 by bob in Medicare
The day you thought would never come is almost here. Your 65th birthday approaches. Wasn’t it just yesterday you were listening to your transistor radio and wondering what to do with your life? But this is no time for reminiscing. For the moment, you need to focus on your future. In particular, you need to think about your health care and how you’ll pay for it.
You’re probably aware that you qualify for Medicare at 65, but to be honest, you have questions about how it works. Let’s start by going over 10 essential facts about Medicare.
If you don’t already get Social Security, you’ll have to apply for Medicare benefits. You can sign up from about three months before you turn 65 until about three months after. Social Security will help you enroll – including online, if you’d like. Visit socialsecurity.gov or call 1-800-772-1213.
Meet your enrollment deadline or pay a penalty. Sign up at 65 if you don’t have insurance from your or your spouse’s current employer. After 65, you should enroll within eight months of quitting work. Otherwise, you could be penalized in the form of permanently higher premiums when you do sign up.
Medicare isn’t free; it comes with costs. Like other insurance, you pay premiums each month and then a deductible, plus co-payments or co-insurance, when you receive care. You may be able to avoid some of those costs if you qualify for a low-income program or purchase supplemental insurance.
Medicare doesn’t cover everything. There are some services Medicare won’t pay for, such as routine dental or eye care, dentures and hearing aids. Also, some people mistakenly believe Medicare covers long-term custodial care in a nursing home or assisted-living center. It doesn’t.
Poor health won’t affect your Medicare coverage. You can’t be denied health care coverage or charged higher premiums because of a current or previous health condition. If you’re eligible for Medicare, you receive full benefits regardless of any medical problems, and at the same cost as everyone else.
You may qualify for help with your drug expenses. If you’re on a tight budget, you may get help paying for the premiums, deductible and co-payments in your Medicare drug plan. Visit socialsecurity.gov or call 1-800-772-1213. Also, ask whether you qualify for help with other Medicare costs.
You can buy private insurance to bolster your Medicare coverage. Because Medicare usually pays for most, but not all, of your health care costs, you may want to shop for additional coverage sold by private insurers. You can join a Medicare Advantage plan or buy supplemental “Medigap” coverage.
Higher-income Americans pay higher Medicare premiums. Most people with Medicare pay $104.90 per month for their Part B medical insurance, but individuals with annual incomes higher than $85,000 (and married couples with yearly incomes above $170,000) will pay a surcharge on top of that amount.
Medicare is emphasizing preventive care. Medicare now covers a number of screenings and preventive services, like mammograms and colonoscopies, at no cost. You’re also entitled to a “Welcome to Medicare” preventive visit your first year and an annual wellness visit after that, again, at no cost.
You have a right to appeal. If you disagree with a coverage or payment decision made by Medicare or a Medicare health plan, you can file an appeal. If you think your health may be hurt by waiting for a ruling, you can ask for a fast decision. To learn more about the process, visit medicare.gov/appeals.
These 10 Essential Medicare Facts are described in more detail in the “Medicare and You 2105” handbook. You can download a free copy at medicare.gov or request one by calling 1-800-633-4227.
And, by the way, happy 65th!
Bob Moos is Southwest public affairs officer for the U.S. Centers for Medicare and Medicaid Services.
