- What is Medicare?
- Medicare is a federal health insurance program for people aged 65 and older.
- Am I eligible for Medicare if I’m under 65?
- Yes, if you have certain disabilities or specific medical conditions.
- What’s the difference between Original Medicare and Medicare Advantage?
- Original Medicare is government-run, while Medicare Advantage is offered by private insurers.
- Do I need Medicare Part A and B?
- Generally, yes. Part A covers hospital costs, and Part B covers medical services.
- Can I have Medicare and Medicaid at the same time?
- Yes, many people qualify for both programs.
- Are prescription drugs covered by Original Medicare?
- No, you’ll need a separate Part D plan for prescription coverage.
- What is Medigap or Medicare Supplemental Insurance?
- It fills gaps in Original Medicare coverage, like copayments and deductibles.
- Can I switch between Original Medicare and Medicare Advantage?
- Yes, during specific enrollment periods.
- What is the “doughnut hole” in Medicare Part D?
- It’s a gap in prescription drug coverage where you pay more until catastrophic coverage kicks in.
- Are preventive services covered by Medicare?
- Yes, many preventive services are covered to keep you healthy.
- How does Medicare cover home health care?
- Part A and Part B cover certain home health care services.
- Can I see any doctor with Medicare Advantage?
- Generally, you must use network providers, but some plans offer flexibility.
- Do I need Medicare if I have employer-sponsored insurance after 65?
- It depends; visit https://www.ssa.gov/medicare/sign-up for online signup or consult your local Social Security office.
- How much does Medicare cost?
- Costs vary; factors include income, coverage choices, and overall health.
- What is the Income-Related Monthly Adjustment Amount (IRMAA)?
- It’s an extra cost for higher-income individuals with Medicare.
- Are dental and vision services covered by Medicare?
- Original Medicare has limited coverage; consider a Medicare Advantage plan for more extensive coverage.
- Can I enroll in Medicare online?
- Absolutely! To sign up online, visit https://www.ssa.gov/medicare/sign-up. Alternatively, if you prefer in-person assistance, head to your nearest Social Security office for personalized guidance.
- What is the Medicare Open Enrollment Period?
- It’s the time each year when you can make changes to your Medicare coverage. Oct. 15 to Dec. 7
- How do I appeal a Medicare decision?
- Follow the instructions on your Medicare Summary Notice or visit https://www.ssa.gov/medicare/sign-up for assistance.
- What’s the difference between Medicare and Medigap?
- Medicare is the federal health insurance program; Medigap is supplemental insurance to cover additional costs.
- Can I have a Health Savings Account (HSA) with Medicare?
- No, you can’t contribute to an HSA once you enroll in Medicare.
- Is nursing home care covered by Medicare?
- It’s limited; Medicare covers short-term stays for specific reasons.
- What’s the difference between Medicare and Medicaid?
- Medicaid is a joint federal and state program for lower-income individuals; Medicare is federal and primarily for seniors.
- Can I get Medicare if I’m still working?
- Yes, but your employer’s coverage might be primary until you retire.
- What is the “Welcome to Medicare” preventive visit?
- Is a one-time appointment you can choose to receive when you are new to Medicare within the first 12 months of enrolling to discuss health goals.
- How do I choose a Medicare Advantage plan?
- Consider your health needs, preferred doctors, and the plan’s costs and coverage. Contact a licensed insurance agent. (915-503-9075)
- Can I get Medicare if I’ve never worked?
- You may qualify through a spouse’s work history.
- Is acupuncture covered by Medicare?
- Limited coverage; some Medicare Advantage plans offer additional benefits.
- What is the Medicare Part B late enrollment penalty?
- It’s an extra fee if you don’t sign up for Part B when first eligible, unless you have creditable coverage.
- Can I use telehealth services with Medicare?
- Yes, especially relevant in recent times; many services are available remotely.
- What does Medicare cover when traveling abroad?
- Very limited coverage; consider additional travel insurance.
- Can I drop my employer health coverage for Medicare?
- Consult with your employer and Medicare to make an informed decision.
- Is weight loss surgery covered by Medicare?
- It can be covered if certain criteria are met.
- What’s the difference between inpatient and outpatient care?
- Inpatient care involves staying overnight; outpatient care doesn’t require an overnight stay.
- Are hearing aids covered by Medicare?
- Original Medicare doesn’t cover them; consider Medicare Advantage or supplemental plans.
- Can I switch from Medicare Advantage to Original Medicare?
- Yes, during specific enrollment periods.
- What is the Medicare Savings Program?
- It helps lower-income individuals with Medicare costs.
- Are over-the-counter drugs covered by Medicare?
- Usually not, but some plans may offer limited coverage.
- What’s the difference between a copayment and a coinsurance?
- A copayment is a fixed amount; coinsurance is a percentage of the cost.
- How do I report Medicare fraud?
- Contact the Inspector General’s office or use the online reporting tool.
- Can I get prescription drugs through mail-order with Medicare?
- Yes, many Part D plans offer this convenient option.
- What is the Medicare Summary Notice (MSN)?
- It’s a summary of your Medicare claims and costs; review it regularly.
- Are chiropractic services covered by Medicare?
- Limited coverage; consider supplemental plans or Medicare Advantage plans for more comprehensive coverage.
- What is the Income-Related Monthly Adjustment Amount (IRMAA) for Part D?
- It’s an extra cost for higher-income individuals with Part D coverage.
- Can I have both Medicare and Veterans Affairs (VA) benefits?
- Yes, you can use both; they complement each other.
- What’s the difference between Medicare Advantage HMO and PPO plans?
- HMOs often require referrals; PPOs offer more flexibility in choosing providers.
- Can I get Medicare if I’m not a U.S. citizen?
- In some cases, non-citizens may be eligible; consult with Social Security for details.
- How does Medicare cover mental health services?
- Part B covers outpatient services; some Medicare Advantage plans offer broader coverage.
- Are ambulance services covered by Medicare?
- Yes, if it’s medically necessary, and you’re transported to a facility that can’t be reached by other means.
- Can I get coverage for prescription drugs without Part D?
- Generally, no; consider enrolling in a Part D plan for drug coverage.
- What is the Extra Help Program for prescription drug costs?
- It assists individuals with limited income in paying for their prescription drugs.
- How does Medicare cover chemotherapy?
- Part B generally covers chemotherapy services; check with your provider for specifics.
- Can I have Medicare if I’m working past 65 and have employer coverage?
- Yes, you can delay Medicare enrollment without penalties as long as you have credible coverage.
- What is the Medicare Special Enrollment Period for disabilities?
- It allows those under 65 with certain disabilities to enroll in Medicare outside the initial enrollment period.
- Are mental health medications covered by Medicare?
- Part D plans cover a range of prescription drugs, including those for mental health.
- Can I get coverage for medical equipment with Medicare?
- Yes, Part B covers certain medically necessary equipment; check coverage details.
- What is the Medicare Star Rating system for Advantage plans?
- It assesses the quality and performance of Medicare Advantage plans.
- Are diabetes supplies covered by Medicare?
- Yes, Part B covers certain supplies and services for managing diabetes.
- Can I get coverage for home modifications with Medicare?
- Generally no, but some state programs or Medicare Advantage plans may offer limited assistance.
- How does Medicare cover preventive screenings for cardiovascular disease?
- Part B covers screenings like cholesterol and blood pressure tests.
- Can I get coverage for physical therapy with Medicare?
- Yes, Part B covers medically necessary outpatient therapy services.
- What is the Medicare demonstration program for innovative care models?
- It tests new ways to deliver and pay for health care services.
- How does Medicare cover hospice care?
- Part A covers hospice care for those with a terminal illness.
- Can I get coverage for acupuncture for chronic pain with Medicare?
- Limited coverage; consider Medicare Advantage plans for additional benefits.
- What is the Medicare Part B excess charge?
- It’s an additional cost you may pay if a doctor charges more than the Medicare-approved amount.
- Can I have both Medicare and Marketplace coverage?
- Generally, no; you must choose one or the other.
- How does Medicare cover skilled nursing facility (SNF) care?
- Part A covers a certain number of days in a skilled nursing facility after a hospital stay.
- What is the Medicare Electronic Health Record (EHR) Incentive Program?
- It encourages health care providers to adopt and use EHRs to improve patient care.
- Are weight loss programs covered by Medicare?
- Typically not, but some services related to obesity may be covered.
- Can I have a Medicare Advantage plan and a Health Reimbursement Account (HRA)?
- It depends on the specifics of your HRA; consult with your plan and employer.
- How do I change my Medicare address or personal information?
- Update your information on the Social Security website or contact them directly.
- What is the Medicare PACE program?
- The Program of All-Inclusive Care for the Elderly (PACE) provides comprehensive care for certain individuals.
- Can I switch from a Medicare Advantage plan to Original Medicare?
- Yes, during specific enrollment periods.
- Are nutritional supplements covered by Medicare?
- Generally not, unless prescribed by a doctor for a specific medical condition.
- What is the Medicaid Buy-In program for working individuals with disabilities?
- It allows people with disabilities who are working to qualify for Medicaid.
- How does Medicare cover mental health hospital stays?
- Part A covers inpatient mental health care; Part B covers outpatient services.
- Can I get coverage for telemedicine with Medicare?
- Yes, especially valuable for remote consultations; check with your plan for details.
- What does Medicare cover when traveling abroad?
- Very limited coverage; consider additional travel insurance.
- Can I drop my employer health coverage for Medicare?
- Consult with your employer and Medicare to make an informed decision.
- Is weight loss surgery covered by Medicare?
- It can be covered if certain criteria are met.
- What’s the difference between inpatient and outpatient care?
- Inpatient care involves staying overnight; outpatient care doesn’t require an overnight stay.
- Are hearing aids covered by Medicare?
- Original Medicare doesn’t cover them; consider Medicare Advantage or supplemental plans.
- Are over-the-counter drugs covered by Medicare?
- Usually not, but some plans may offer limited coverage.
- A copayment is a fixed amount; coinsurance is a percentage of the cost.
- Are eyeglasses covered by Medicare?
- Original Medicare typically doesn’t cover routine eye exams or glasses.
- How do I find out if my prescription is covered by my Part D plan?
- Check the plan’s formulary or contact the plan directly for information.
- What is the Medicare Advantage Disenrollment Period?
- It allows you to disenroll from a Medicare Advantage plan and return to Original Medicare; it runs from January 1 to February 14.
- Are preventive vaccines covered by Medicare?
- Yes, Medicare covers many vaccines to prevent illness.
- Can I enroll in a Medicare Advantage plan if I have end-stage renal disease (ESRD)?
- In some cases, you may be eligible under specific circumstances.
- Are cosmetic surgeries covered by Medicare? – Generally not, unless medically necessary.
- What is a Medicare Advantage plan?
- A Medicare Advantage plan, also known as Medicare Part C, is a private insurance plan that combines and replaces the benefits offered by Original Medicare (Part A and Part B). These plans are offered by private insurance companies approved by Medicare.
- What additional benefits do Medicare Advantage plans typically provide?
- In addition to the coverage provided by Original Medicare, Medicare Advantage plans often include extra benefits such as vision, dental, hearing, and prescription drug coverage. Some plans may also offer fitness and wellness programs.
- How do Medicare Advantage plans differ from Original Medicare?
- While Original Medicare is a government-run program, Medicare Advantage plans are offered by private insurance companies. These plans must cover at least the same benefits as Original Medicare but can offer additional services and may have different rules and costs.
- What are the different types of Medicare Advantage plans?
- Medicare Advantage plans include Health Maintenance Organization (HMO) plans, Preferred Provider Organization (PPO) plans, Private Fee-for-Service (PFFS) plans, Special Needs Plans (SNPs), and Medical Savings Account (MSA) plans. Each type has its own features and restrictions.
- Do all Medicare Advantage plans include prescription drug coverage?
- No, not all Medicare Advantage plans include prescription drug coverage. However, many plans, known as Medicare Advantage Prescription Drug (MAPD) plans, combine medical and prescription drug coverage in a single plan.
- Can I switch from Original Medicare to a Medicare Advantage plan, or vice versa?
- Yes, you can switch from Original Medicare to a Medicare Advantage plan during the annual enrollment period (October 15 to December 7). You can also switch back to Original Medicare during the Medicare Advantage Open Enrollment Period (January 1 to March 31).
- What is the maximum out-of-pocket limit for Medicare Advantage plans?
- Medicare Advantage plans have a yearly limit on out-of-pocket costs for covered services. Once you reach this limit, the plan typically covers all additional costs for the rest of the year.
- Can I use any healthcare provider with a Medicare Advantage plan?
- The network of healthcare providers varies depending on the type of Medicare Advantage plan. HMO plans usually require members to use a network of providers, while PPO plans offer more flexibility but may have higher costs for out-of-network services.
- Are preventive services covered by Medicare Advantage plans?
- Yes, Medicare Advantage plans cover the same preventive services as Original Medicare, such as vaccinations, screenings, and wellness exams. Many plans also offer additional preventive benefits not covered by Original Medicare.
- How does the star rating system help in choosing a Medicare Advantage plan?
- The Centers for Medicare & Medicaid Services (CMS) assigns star ratings to Medicare Advantage plans based on various factors, including customer satisfaction, quality of care, and member outcomes. A higher star rating generally indicates better performance, and beneficiaries can use this information to compare and choose plans.
- Who can help me find a Medicare Advantage plan?
- Call: 915-503-9075
100 Medicare Frequently Asked Questions
