If Medicare options and information are making your head spin, you’re not alone. Norgard Insurance Group is here to help you choose coverage that makes sense.
What is Medicare? We all feel like we have a sense of what Medicare insurance is all about, but it can be confusing to try to understand exactly what Medicare is, who it benefits, and what the coverage includes. We’re here to help break it all down. Let’s take a look at everything you need to know about Medicare.
What is Medicare?
Medicare is a health insurance program run by the federal government. The federal agency that runs the Medicare program is called CMS or the Centers for Medicare and Medicaid Services. The insurance program is funded partly by Social Security and Medicare taxes that everyone pays into with their income taxes. People who receive Medicare also pay premiums that support the program, and the rest is funded by the federal government budget.
Who Qualifies for Medicare?
Medicare availability extends to individuals who are 65 years old or older. It also covers individuals of any age who suffer from End-Stage Renal Disease (ESRD), which is kidney failure that requires specific care, including dialysis or a kidney transplant. Medicare also serves as limited-term coverage for people on Social Security Disability Insurance.
There are two parts to Medicare coverage: Part A, which is hospital insurance, and Part B, which is medical insurance. For individuals age 65 or older to qualify for premium-free Part A coverage, they must meet these requirements:
- You or your spouse must have paid Medicare taxes via employer tax withholding for at least ten years.
- You are eligible for, or currently receive, Social Security or Railroad Retirement Board retirement benefits.
- You or your spouse were government employees covered by Medicare
Not everyone is entitled to premium-free coverage with Medicare. If you did not pay Medicare taxes via your employment, but you are age 65 or older, are a United States citizen or permanent resident, you can buy Part A. If you are under the age of 65, you may be eligible for zero-premium Part A benefits if you:
- Are entitled to Social Security or Railroad Retirement Board disability benefits for 24 months
- Are on kidney dialysis or are a kidney transplant patient
The good news is, the majority of Medicare patients do not pay Part A premiums. This means you won’t pay a premium should you require inpatient hospital care. When it comes to Medicare Part B, however, everyone must pay a monthly premium. For those covered by Medicare Part B, the premiums are deducted from your Social Security, Railroad Retirement, or Civil Service retirement payments. If you do not receive any of these payments, you will receive a quarterly bill for your Part B premiums.
What Does Medicare Cover?
The first question most people have when signing up for a new insurance plan is: what does it cover? Like most insurance programs, there are different plans and different items covered with Medicare. Some of your coverage will depend on where you live and some on the type of Medicare plan you sign up for or qualify for.
Part A covers inpatient hospital stays, inpatient stays in a skilled nursing facility, certain types of home health or nursing care, and hospice care. Part B is the Medicare medical insurance coverage that includes visits to doctors and other healthcare providers, outpatient services, durable medical equipment, home health care, and certain preventative services. There are other levels of coverage, including Medicare Advantage, that offer additional coverage if needed.
How to Enroll
Signing up for Medicare might seem complicated, but it is actually much easier, in most cases, than signing up for standard insurance policies. Here are the ways you can enroll in Medicare coverage through Social Security:
- If you are already receiving Social Security benefits before you turn 65, you will automatically be enrolled in Medicare coverage. You will receive a Medicare welcome letter three months before you turn 65.
- If you are not receiving Social Security benefits at the time you turn 65, you will need to sign up for both Social Security benefits as well as Medicare coverage. You can do this within the three months before or after you turn 65. Keep in mind this timeframe does include the month you turn 65. Enrolling before the month of your birthday can prevent potential delays in coverage.
The team at Norgard Insurance Group is here to help with your Medicare enrollment when the time comes.
There are five different Medicare plans available, depending on your needs and qualifications. They include:
- Medicare Part A – hospital coverage
- Medicare Part B – standard health insurance coverage
- Medicare Part C – also referred to as Medicare Advantage or Medicare Supplement. This plan is Medicare insurance offered through private, Medicare-approved insurance providers
- Medicare Part D – prescription drug coverage
While Medicare offers invaluable insurance coverage, it is not as complete as some people might require. This is where supplemental Medicare plans come into play. A Medicare supplement plan helps round out your coverage where there may be gaps, known as Medigaps.
Because everyone’s needs are different, supplemental plans work with each individual’s financial and health requirements. Norgard Insurance Group can assess your situation and help you choose the right Medicare options for your budget and your healthcare needs.
How Much Does Medicare Cost?
Nothing is free, and that includes Medicare coverage. Though the plans are highly subsidized by the federal government and Medicare taxes, the cost of coverage for all qualified Americans is still too great to provide it for free. Here is a high-level overview of the costs associated with each Medicare plan:
- Medicare Part A – Hospital Stay
- $0 for the first 60 days in your benefit period
- $352 per day for days 61-90 of each benefit period
- $704 per day after day 90 of each benefit period, with a maximum of 60 days over your lifetime
- Medicare Part A – Skilled Nursing
- $0 for the first 20 days of each benefit period
- $176 per day for days 21-100 of each benefit period
- You are responsible for all costs for each day after day 100 of each benefit period
- Medicare Part B – Medical Insurance
- Monthly premium – in 2020 the monthly premium amount for paid plans starts at $144.60 and goes up, dependent on your income
- Monthly premium for Social Security benefit plans – the average monthly premium is $130 but varies based on your Social Security benefits
Be mindful that the Medicare benefit period for hospital and skilled nursing inpatient care starts on the day of admission to the healthcare facility and ends 60 days after the point at which you no longer require or receive inpatient care.
Medicare vs. Medicaid
It’s easy to confuse Medicare and Medicaid. They’re both government health insurance programs, and though they each serve a different population, there is some overlap.
Medicare is the federal insurance program specifically designed for individuals who are age 65 or older, have disabilities, or are in renal failure. These individuals paid into the Medicare program through their income taxes, and they must pay part of the costs through their premiums and deductibles. Income is not a factor in Medicare coverage, as it is offered to all qualified individuals based on age and requirements.
Medicaid, on the other hand, is a program run on the state and local level with federal oversight to provide health insurance and coverage to very low-income individuals and their families. It’s an assistance program that covers medical expenses at no cost to the patient. There is a Medicaid program for each state, which is responsible for setting income and asset requirements and restrictions.
The eligibility requirements for Medicaid are stricter than for Medicare because it’s designed to specifically assist low-income adults and children who might not have any other way to access healthcare resources. If you are receiving Medicaid benefits when you turn 65, your Medicare benefits will overlap those benefits to help cover your medical expenses.
What is "Medicare for All?"
The “Medicare for All” Act is highly debated on both sides of the political aisle. Leaving the deliberation to the politicians, it’s important for Americans to understand this potential Medicare program and what it entails. The fundamentals of the plan include single-payer health care that is run by the federal government, similar to the existing Medicare program. What does this mean for individual insurance providers? It would essentially replace all other public and private health insurance programs. It would be a version of Medicare that would cover all Americans.
Supporters of the Medicare for All plan believe that healthcare is a right and should be provided by the government so no one is excluded based on income, where they live, or what pre-existing conditions they may have. Critics believe it to be cost-prohibitive and disruptive to individuals who get their insurance plans through their employers’ benefits packages.
How Norgard Insurance Group Can Help Simplify the Process
Are you confused by all of the information related to Medicare? You’re not alone. Medicare program information, plans, and enrollment can be overwhelming, and it can be daunting to try to navigate the waters of health insurance coverage once you get to retirement age.
The good news is, Norgard Insurance Group is here to help you get the Medicare coverage that’s right for you. We will look at your situation, assess your needs, and work with you to find the best coverage. Whether you need basic Medicare or require supplemental Medicare plans to complement your Medicare coverage, we’ve got you covered. Let us do the legwork to get your Medicare plan in place before you need it.