Medicare Basics
What is the purpose of Medicare?
To provide health insurance for people aged 65 and older, and younger people with certain disabilities or ESRD
At what age do most individuals become eligible for Medicare?
65
What does Medicare Part A cover?
Hospital stays, skilled nursing facility care, hospice care, and limited home health care.
Is Medicare Part A premium-free for most beneficiaries?
Yes, if they or their spouse have paid Medicare taxes for at least 10 years.
What is the primary difference between Original Medicare and Medicare Advantage?
Medicare Advantage (Part C) plans are offered by private insurers and include additional benefits, while Original Medicare is government-run and has fewer additional benefits.
Who administers Medicare?
The Centers for Medicare & Medicaid Services (CMS)
What is the Initial Enrollment Period (IEP)?
A seven-month window around a person’s 65th birthday to enroll in Medicare, starting 3 months before the birthday, including the birthday month, and ending 3 months after.
What does Medicare Part B cover?
Doctor visits, outpatient care, preventive services, and medical equipment.
What is the standard premium for Medicare Part B in 2024?
$174.70 per month (this amount can change annually)
Do Medicare Advantage plans include prescription drug coverage?
Many Medicare Advantage plans include Part D prescription drug coverage.
What are the two main components of Original Medicare?
Part A (Hospital Insurance) and Part B (Medical Insurance).
Can individuals under 65 qualify for Medicare? If so, how?
Yes, people under 65 can qualify if they have been receiving Social Security Disability Insurance (SSDI) for 24 months, or have End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS).
What is Medicare Part C?
Also known as Medicare Advantage, it’s an alternative to Original Medicare offered by private insurers, bundling Parts A and B, and often includes additional benefits.
What is coinsurance?
The percentage of costs that a Medicare beneficiary pays after meeting the deductible, typically 20% for services covered under Part B.
What is Medigap, and how does it work with Original Medicare?
Medigap is supplemental insurance that helps pay for out-of-pocket costs like deductibles, coinsurance, and copayments not covered by Original Medicare.
When was Medicare established?
1965
What happens if a beneficiary misses their Initial Enrollment Period?
They may face a late enrollment penalty and will have to wait until the General Enrollment Period (January 1 - March 31) to sign up for Medicare Part B.
What does Medicare Part D cover?
Prescription drug coverage.
What is the Medicare Part B deductible for 2024?
$240 (this can change yearly)
What are the typical extra benefits that Medicare Advantage plans offer?
Medicare Advantage plans often include additional benefits like dental, vision, hearing, and fitness memberships.
What legislation introduced Medicare?
The Social Security Act Amendments of 1965, signed by President Lyndon B. Johnson.
What is a Special Enrollment Period (SEP)?
It’s a period that allows individuals to enroll in Medicare outside the standard enrollment windows, typically triggered by certain life events such as loss of employer-sponsored coverage.
What’s the difference between Medicare Advantage (Part C) and Medicare Supplement Plans (Medigap)?
Medicare Advantage plans are alternatives to Original Medicare, offering a bundle of services including additional benefits, while Medigap is supplemental insurance that fills in the gaps in Original Medicare (Parts A and B).
What is IRMAA, and how does it affect Medicare costs?
Income-Related Monthly Adjustment Amount (IRMAA) is an additional charge for higher-income beneficiaries on their Medicare Part B and Part D premiums.
Can someone have both a Medicare Advantage plan and a Medigap policy?
No, beneficiaries cannot have both a Medicare Advantage plan and a Medigap policy.