Medicare

Find Answers to Questions About Medicare

Is there help for me if I can’t afford Medicare’s premiums? open Is there help for me if I can’t afford Medicare’s premiums?

There are four Medicare Savings Programs (MSP) available to people who have low income and limited resources^[0]. 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, and/or the Part B deductible. To find out if you qualify for one of these programs, reach out to your local Medicaid office.

Is there help for me if I can’t afford Medicare’s premiums?

There are four Medicare Savings Programs (MSP) available to people who have low income and limited resources^[1]. 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, and/or the Part B deductible. To find out if you qualify for one of these programs, reach out to your local Medicaid office.

Do I need to sign up for Medicare at 65 if I’m still working? open Do I need to sign up for Medicare at 65 if I’m still working?

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 and ends three months after your birthday^[0].

Many people continue to work after 65, especially since the retirement age for full Social Security benefits is 67^[1]. If you are working in a job that employs more than 20 full-time employees and offers an employer group health plan (as defined by the IRS) – or if your spouse is the one continuing to work and you’re covered under their 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.

Do I need to sign up for Medicare at 65 if I’m still working?

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 and ends three months after your birthday^[2].

Many people continue to work after 65, especially since the retirement age for full Social Security benefits is 67^[3]. If you are working in a job that employs more than 20 full-time employees and offers an employer group health plan (as defined by the IRS) – or if your spouse is the one continuing to work and you’re covered under their 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.

Does Medicare cover dental or vision? open Does Medicare cover dental or vision?

Original Medicare does not include routine dental and vision screening as a benefit^[0]. 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 pay toward some vision care that directly relates to medical conditions like 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 offer dental and vision coverage as a supplemental benefit^[1]. You will need to read the plan benefits to find out what specific services are covered. There is often a cap set on how much they will pay toward these services each year.

Does Medicare cover dental or vision?

Original Medicare does not include routine dental and vision screening as a benefit^[2]. 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 pay toward some vision care that directly relates to medical conditions like 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 offer dental and vision coverage as a supplemental benefit^[3]. You will need to read the plan benefits to find out what specific services are covered. There is often a cap set on how much they will pay toward these services each year.

Does Medicare replace my current insurance? open Does Medicare replace my current insurance?

Before you make any major decisions, you will want to talk to your employer to see how their health coverage interacts with 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^[0]. Or you may have to enroll in both parts of Medicare, with your employer’s plan providing secondary coverage. 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. The decision about your ongoing health coverage should only be made after you’ve discussed the details with your employer.

Note: You cannot buy an individual (self-purchased) health plan after you’re enrolled in Medicare. 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 Medicare (meaning you’d pay full price for the individual plan), and Medicare does not coordinate benefits with individual health coverage^[1]. So in most cases, it’s not in your best interest to maintain an individual market plan in addition to Medicare.

Does Medicare replace my current insurance?

When you sign up for Medicare, 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 will want to talk to your employer to see how their health coverage interacts with 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^[2]. Or you may have to enroll in both parts of Medicare, with your employer’s plan providing secondary coverage. 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. The decision about your ongoing health coverage should only be made after you’ve discussed the details with your employer.

Note: You cannot buy an individual (self-purchased) health plan after you’re enrolled in Medicare. 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 Medicare (meaning you’d pay full price for the individual plan), and Medicare does not coordinate benefits with individual health coverage^[3]. So in most cases, it’s not in your best interest to maintain an individual market plan in addition to Medicare.

Can I keep my doctors when I enroll in Medicare? open Can I keep my doctors when I enroll in Medicare?

More than 99% of doctors have not opted out of accepting Medicare patients.^[0]. That said, whether you get to keep your current doctors will depend on what type of Medicare you choose.

People with Original Medicare can see any doctor that 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.

Can I keep my doctors when I enroll in Medicare?

More than 99% of doctors have not opted out of accepting Medicare patients.^[1]. That said, whether you get to keep your current doctors will depend on what type of Medicare you choose.

People with Original Medicare can see any doctor that 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.

Medicare vs Medicaid: What’s the difference between Medicare and Medicaid? open Medicare vs Medicaid: What’s the difference between Medicare and Medicaid?

open Medicare vs Medicaid: What’s the difference between Medicare and Medicaid?

Medicare and Medicaid are both government-run health coverage programs. But they differ in terms of eligibility, benefits, funding, and administration.

Medicare is funded and regulated by the federal government, while Medicaid is funded and regulated jointly by the federal government and the states.

Medicare covers Americans 65 and older or those who have a qualifying disability or ESRD. The main coverage benefits are standardized nationwide. Medicare Advantage plans can add on services, i.e., extra benefits, as long as they meet federal guidelines. Medicare is funded by payroll taxes, general revenue, and premiums that beneficiaries pay. There is no income limit for Medicare eligibility, although Medicare beneficiaries with very high incomes may pay higher premiums for Medicare Part B and Part D.

Medicaid, on the other hand, is geared toward people with low incomes and the medically needy. 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. Some states limit coverage to 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.

Medicare vs Medicaid: What’s the difference between Medicare and Medicaid?

Medicare and Medicaid are both government-run health coverage programs. But they differ in terms of eligibility, benefits, funding, and administration.
Medicare is funded and regulated by the federal government, while Medicaid is funded and regulated jointly by the federal government and the states.
Medicare covers Americans 65 and older or those who have a qualifying disability or ESRD. The main coverage benefits are standardized nationwide. Medicare Advantage plans can add on services, i.e., extra benefits, as long as they meet federal guidelines. Medicare is funded by payroll taxes, general revenue, and premiums that beneficiaries pay. There is no income limit for Medicare eligibility, although Medicare beneficiaries with very high incomes may pay higher premiums for Medicare Part B and Part D.
Medicaid, on the other hand, is geared toward people with low incomes and the medically needy. 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. Some states limit coverage to 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.