Medicare FAQs

Medicare is a federal health insurance program that provides coverage for individuals who are 65 years or older, as well as for certain younger individuals with disabilities or specific medical conditions. Medicare has four parts:

• Part A: Hospital Insurance, which covers inpatient hospital stays, skilled nursing care, hospice care, and some home health care.
• Part B: Medical Insurance, which covers doctor visits, outpatient care, preventive services, and some home health care.
• Part C: Medicare Advantage Plans, which are private insurance plans that combine Part A and Part B coverage, and often include prescription drug coverage as well.
• Part D: Prescription Drug Coverage, which helps pay for prescription medications.

Medicaid is a joint federal and state program that provides health insurance to low-income individuals and families. Eligibility for Medicaid is based on income and other factors, and coverage varies by state. In addition to basic healthcare services, Medicaid may also cover long-term care, home and community-based services, and other benefits.

Yes, it is possible to have both Medicare and Medicaid. This is known as being “dual-eligible.” If you qualify for both programs, you can receive coverage through both Medicare and Medicaid, which can help cover a wider range of healthcare services and costs.

While both Medicare and Medicaid are government programs that provide health coverage, there are some key differences between the two:

• Medicare is a federal program that provides coverage primarily for older adults and individuals with disabilities, while Medicaid is a joint federal and state program that provides coverage primarily for low-income individuals and families.
• Medicare has different parts that cover specific services, such as hospital stays, doctor visits, and prescription drugs, while Medicaid coverage varies by state and may include a broader range of services.
• Medicare is available to all individuals who meet eligibility criteria, while Medicaid eligibility is based on income and other factors, and varies by state.

You can apply for Medicare online through the Social Security Administration’s website, by calling Social Security at 1-800-772-1213, or by visiting your local Social Security office. If you are already receiving Social Security benefits, you will be automatically enrolled in Medicare Part A and Part B when you turn 65.

You can apply for Medicare during your Initial Enrollment Period, which is a seven-month period that starts three months before the month you turn 65, includes the month you turn 65, and ends three months after the month you turn 65. If you miss your Initial Enrollment Period, you may have to pay a late enrollment penalty and may have to wait to enroll during the General Enrollment Period, which runs from January 1 to March 31 each year.

The Medicare Open Enrollment Period is a yearly period when you can make changes to your Medicare coverage. The Open Enrollment Period runs from October 15 to December 7 each year, and during this time, you can switch from Original Medicare to a Medicare Advantage Plan, switch from one Medicare Advantage Plan to another, or add, drop, or change your prescription drug coverage.

Original Medicare is the traditional fee-for-service program offered by the federal government. It includes Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance). With Original Medicare, you can see any doctor or healthcare provider who accepts Medicare, and you do not need referrals to see specialists.

Medicare Advantage Plans, on the other hand, are private insurance plans that are approved by Medicare. These plans provide all of your Part A and Part B coverage, and many also offer additional benefits such as prescription drug coverage, vision and dental care, and fitness programs. Medicare Advantage Plans often have network restrictions and may require referrals to see specialists.

In summary, Original Medicare gives you more flexibility in choosing healthcare providers, while Medicare Advantage Plans may offer additional benefits but have more restrictions on where you can receive care.

Medicare Part D is a government program that helps pay for prescription medications. Part D coverage is provided through private insurance companies that are approved by Medicare. If you have Original Medicare or a Medicare Advantage Plan that does not include prescription drug coverage, you can enroll in a stand-alone Part D Prescription Drug Plan to help cover the cost of your medications.

Choosing a Medicare plan can be a complex decision, but there are resources available to help you navigate your options. You can compare Medicare plans online through the Medicare Plan Finder tool on the Medicare website, or you can contact Next Step Insurance Group for personalized assistance in selecting the plan that best meets your needs.