Concrete answers to 10 common Medicare questions

Published by Medicare Made Clear®

Concrete answers to 10 common Medicare questions

Medicare decisions are highly personal. And there may be as many different questions about Medicare as there are beneficiaries—maybe more. But certain questions seem to come up more often than others. Here are some of the most common Medicare questions and answers.

How do I know what Medicare coverage is right for me?

The answer to this may be easy to say but maybe not as easy to do. You need to understand your personal health care needs and choose Medicare coverage to help meet them. For example, if you take prescription drugs right now, when you get Medicare, you need to make sure you get Part D prescription drug coverage through either a stand-alone Part D plan or a Medicare Advantage plan.

How much does Medicare cost?

You will likely pay the Part B premium to Medicare. Beyond that, you may pay other premiums, deductibles, co-pays and co-insurance. The total amount you pay will depend on the type of Medicare plan(s) you choose and the health care services you use during the year.

Learn more about Medicare coverage and costs.

What do I do about Medicare if I work past age 65?

If you plan to work past 65, you may be able to delay enrolling in Medicare. Or, you may have to enroll during your Initial Enrollment Period in Parts A, B and D if you want to avoid late penalties.  It will depend on your employer and if your employer coverage is creditable. You can find out what you need to do about Medicare when continuing to work here.

Some people who can delay Medicare still choose to enroll in just Part A when they turn 65 in addition to their employer coverage. Part A is premium free if you or your spouse worked and paid Medicare taxes for at least 10 years. Note though, if you do get Part A, you can no longer contribute to your HSA.

How can I get dental and vision coverage with Medicare?

Original Medicare (Parts A & B) does not cover routine dental or vision care; however, some Medicare Advantage (Part C) plans do. Plans include all the coverage provided by Parts A and B, and often additional benefits like dental, vision, hearing and gym memberships, all in one plan.

Is Medicare mandatory?

No part of Medicare is mandatory, but if you choose to enroll in any part of Medicare after your Initial Enrollment Period, you could face financial penalties unless you qualify for a Special Enrollment Period with creditable employer coverage.

What’s the difference between a Medicare Advantage HMO and PPO?

A Medicare Advantage HMO plan usually helps pay only for care you receive from providers in the plan network. A PPO plan will generally help pay for care received outside the plan network, but it may pay less than for the same care received within the network.

Where can I get help paying for Medicare?

Financial assistance programs for people with limited income and assets include Extra Help for prescription drugs, Medicare Savings Programs and Medicaid, to name a few. Qualifications for each program and the level of help offered vary.

How does Medicare automatic renewal work?

Your Medicare coverage choices will stay in place year after year unless you change your plan. This ensures that your coverage continues, but even if a plan renews, the plan benefits and costs may still change each year. It’s a good idea to review your Medicare choices every year during the Medicare Annual Enrollment Period each fall, which runs Oct. 15 – Dec. 7.

What’s the difference between Medicare and Medicaid?

Medicare and Medicaid are both government health care programs, but they are very different. Medicare is generally for people who are 65 or older, or who have a qualified disability. Medicaid is a state-governed program for people with limited income and resources.  Some people are eligible for both Medicare and Medicaid. These people are considered “dual eligible” and are often qualified for special Medicare plans.

Learn more about Medicare vs. Medicaid and dual eligibility.

I’m disabled. When can I get Medicare?

In general, you are eligible for Medicare after receiving Social Security disability benefits for 24 months. There are exceptions for people with certain medical conditions. Get your enrollment dates and learn more about Medicare and disability.

Do you have additional questions about Medicare?

Medicare is complex, and it can often feel overwhelming when you’re learning about Medicare and shopping around for coverage for the first time. If you have further questions, here is a great Medicare FAQ resource.

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