The moment you turn 65, you qualify for Medicare no matter what your medical history looks like and no matter what kind of medical insurance you used. From this point on, you can take advantage of the government’s collective bargaining powers and subsidies at a time when health problems tend to start stacking up.
However, it’s not all good news. As a government program, Medicare has trouble with adapting to new treatments and medications, plus it still has things like copays and deductibles. It’s also a very large and very old program that has built up some complicated rules and red tape over the years. Medicare can be hard to understand and navigate through no matter who you are, so it always helps to know or refresh yourself about the basics.
Medicare Is Not Always Automatic
With an easy requirement like “you must be 65 to join,” you’d think that the government would make signing up for Medicare automatic. However, that’s not the case; many people are working past 65, and others get coverage from their spouse’s health plan, so they might not need Medicare. Still, enrolling in Medicare can help since both plans can help pay the same medical bills.
Medicare Is Not Always Free
Medicare and Social Security have a few things in common. One is that their taxes are counted separately on federal tax returns, and another is that you have to pay these taxes a certain number of times to get the full benefits. For Medicare, if you pay the tax for 40 quarter-years, you can get Part A (hospital insurance) without a premium. Part B (health insurance) isn’t free, but if you qualify for Social Security, the government will automatically deduct the premiums from your Social Security deposits. You could also pay higher premiums if you don’t sign up at 65.
Part C Is Medicare Advantage
Original Medicare includes Part A and Part B coverage. Part C expands on these by offering Medicare Advantage plans run by third-party insurers. These plans cover Medicare basics, but they can also cover things like dental plans, vision, and prescription drug costs. You’ll still pay your Medicare premiums, so Part C plans usually don’t add much to the monthly payments.
You can also choose to get a Medicare supplemental insurance plan, which is different from Medicare Advantage. Medicare supplemental insurance — or Medigap — plans cover the deductibles and copays determined by Medicare. They can also help you pay in-network prices at any facility that accepts Medicare. However, you can’t pay for Medicare Advantage and a Medigap plan at the same time.
Part D Covers Prescriptions
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Back when the United States government first created Medicare, prescription drugs weren’t a big part of medical costs. That’s changed now, especially in the last few years, so Part D showed up in 2003. Like Part C, Part D is optional, but like Parts A and B, you’ll get a penalty if you enroll late. Assuming you aren’t in a Medicare Advantage plan that covers prescription costs, you can join a Part D plan that will help you with drug prices.
Medicare Doesn’t Cover Long-Term Care
As you grow older, you may find yourself unable to do basic things like putting away groceries, cooking, or picking up heavy packages. That’s why many seniors live in assisted-living housing, and just how much assistance they get depends on the housing and how much the tenant can still do. However, the extra help comes with extra costs, and Medicare doesn’t cover these costs. For that, you should get long-term care insurance.
From a distance, Medicare can look like a giant mess. Still, the basics are easy enough to understand, and you can get a lot more coverage than the basics if you take a look at the available plans and carefully consider what you need and what you can afford. If you can do that, you’ll be well on your way to making the most of your Medicare and any Medicare Advantage or Medigap coverage you buy.