15 critical details to know about Medicare coverage

15 critical details to know about Medicare coverage

Medicare is a federal primary insurance program that is offered to elderly seniors. It is available for both working and retired seniors as a benefit to pay for rising healthcare costs. Even young adults suffering from a disability or those diagnosed with end-stage renal disease can avail of this benefit. Medicare is a complicated insurance program that entitles many tricky terms and conditions. Here are 15 essential things you should know about Medicare.

It’s a government-sponsored insurance
Medicare is something that you can additionally avail over any existing insurance plans to provide coverage for treatment.

You need to apply before you turn 65
Applications start three months before you turn 65 and end four months post your 65th birthday, giving you seven months to enroll for the plans.

There are four parts
Medicare is divided into four main parts, with Part A and B forming the original Medicare. Original covers both the inpatient and outpatient needs, whereas Parts C and D are special advantage plans that help cover special costs and prescriptions.

You can choose between Original and Advantage plans
Original Medicare only covers Part A and B, with an option to choose Part C to pay for prescriptions. Or choose Part C with optional D coverage.

Medicare needs Medigap
Any gaps in original Medicare coverage can be bridged with supplemental insurance using Medigap policies. It’s over and above what is covered by law in original policies.

You have the right to choose
All Medicare Parts are not always mandatory. Once enrolled, you can opt for specific coverage within original or advantage plans, with prescription coverage or supplemental insurance. It’s up to you to avail the benefits you need.

Delayed enrollments increase premiums
If you don’t enroll for Medicare in the initial enrollment period as per the government mandate, you will have to pay high premium costs.

Medigap is subject to eligibility
Medigap supplemental insurance is not always available if you fail to choose it before or after enrolling for Medicare plans in the new year.

Retirement is not the criteria
As soon as you turn 65, it’s better to enroll for healthcare benefits irrespective of existing insurance coverage with the employer. Post-retirement, these plans will be useful.

Medicare is an individual benefit
You cannot enroll in Medicare policies as a family. Only individual members who turn 65 or pass the qualifying criteria can enroll.

Missing enrollment can result in penalties
A late enrollment penalty is levied upon application post the enrollment period. The amount will be adjusted depending on how many months have passed since enrollment.

Social Security benefits enrollment
If you or any other family member already receive certain government-sponsored benefits under Social Security, then you are automatically enrolled in Medicare Part A and B.

You get free preventive services
With Medicare enrollment, you automatically become eligible for a number of free preventive services for healthcare wellness and screening.

You can appeal decisions
Any disagreements with payment and coverage can be challenged in a court of law as per your appeal.

You get one chance to switch coverage
You can update your coverage and select new Medicare policies once annually after the initial enrollment to maximize your benefits.