Medicare

There are four Medicare Savings Programs (MSPs) available to people who have low income and limited resources. Depending on which MSP you qualify for, you could get help paying for Part A premiums, Part B premiums, Part B coinsurance, Part B copayments,  the Part B deductible, or a combination of all of them. To apply, individuals must fill out an application provided by their state’s Medicaid office since medical services for people with low income and limited resources are managed by Medicaid, even when Medicare is involved. The applicant must provide documentation of income, assets, and Medicare enrollment. Eligibility criteria and application processes can vary by state, so check with your local Medicaid office for qualification requirements.

It is important to sign up for Medicare on time to avoid paying late penalties. The initial enrollment period starts three months before you turn 65, continues during your birthday month, and ends three months after your birthday month.

Some people continue to work after they turn 65. If you are working in a job that employs more than 20 full-time employees and offers a group health plan (as defined by the IRS) – or if your spouse is the one continuing to work and you’re covered under your spouse’s plan – you can sign up for Medicare at a later time without facing those late penalties. You have eight months to enroll from the time you leave your job or when you lose your employer-sponsored health plan, whichever comes first.

Original Medicare does not cover routine dental and vision screening as a benefit. This means that corrective lenses (e.g., glasses and contacts), dental cleanings, dentures, and routine eye exams are not covered. Those preventive services aside, it does cover some vision care that directly relates to medical screenings for cataracts, diabetic retinopathy, glaucoma, and macular degeneration. Dental procedures are rarely covered unless they are needed before major surgery (e.g., a kidney transplant or heart surgery) or before radiation treatment for head and neck cancer.

Most Medicare Advantage plans can offer these additional benefits. You will need to read the policy to find out what specific services are covered.

When you sign up for a Medicare plan, you can decide to cancel any other health coverage you have. Alternatively, you can choose to keep it. This may help you pay for services not otherwise covered by Medicare. Before you make any major decisions, you may want to talk to your current carrier to see how your employer-sponsored health coverage interacts with Original Medicare. Depending on the size of the employer, you may be able to delay your enrollment in Medicare Part B, with your employer’s plan providing primary coverage. Or your employer’s plan may provide secondary coverage when you enroll in both parts of Original Medicare. You’ll also need to consider whether you’re willing and able to pay premiums for both the employer’s plan and Medicare Part B. Note: You cannot buy an individual major medical health insurance plan after you’re enrolled in a Medicare plan. But if you already have an individual plan, you are not required to drop it when you enroll in Medicare. However, any Marketplace premium subsidies that you receive would end once you’re enrolled in Original Medicare (meaning you’d pay full price for the individual plan). So, in many cases, it may not be in your best interest to maintain an individual market plan in addition to a Medicare plan.

About 99% of doctors will accept payment from Medicare. That said, whether you get to keep your current doctors will depend on what type of Medicare plan you choose. People with Original Medicare can see any doctor who takes Medicare. Medicare Advantage plans, however, limit their coverage options to a local network of providers. If you do not see a doctor in your plan’s network, you may have to pay more for their services. In some cases, your plan may not cover those visits at all.

Original Medicare and Medicaid are both government-run health coverage programs. But they differ in terms of eligibility, benefits, funding, and administration. Original Medicare is funded and regulated by the federal government, while Medicaid is funded and regulated jointly by the federal government and participating state governments. Original Medicare covers individuals 65 years old and older or those who have a qualifying disability for which they receive benefits, including ALS or ESRD. Medicare Part A and Medicare Part B benefits are standardized nationwide. Medicare Advantage plans can include additional benefits as long as they meet federal guidelines. Original Medicare is funded by payroll taxes, general revenue, and premiums that beneficiaries pay. There is no income limit for Medicare eligibility, although Original Medicare beneficiaries with higher incomes may pay higher premiums for Medicare Part B and Medicare Part D prescription drug plans. Medicaid, on the other hand, is geared toward people with low incomes and other eligible groups. Medicaid programs are run by each state and funding is provided jointly by the state and federal governments. So, states have some flexibility in terms of eligibility rules and the benefits that are provided. Federal law requires states to cover at a minimum eligible children, pregnant women, very low-income parents, and people who are elderly, blind, or disabled. But the majority of the states have adopted Medicaid expansion as part of the Affordable Care Act, which means they also provide Medicaid coverage to low-income adults, even if they don’t have children. Medicaid benefits also vary from state to state; there are federal minimum requirements, but states can choose to provide additional benefits.