11 Key Aspects of Medicare to Know Before Enrolling

11 Key Aspects of Medicare to Know Before Enrolling

Medicare is a federal health insurance initiative that covers treatment expenses for eligible U.S. citizens. The program provides healthcare benefits to senior citizens aged 65 and above. However, younger people with disability and those approved for Social Security disability insurance can also benefit from the program. As part of this initiative, most people in the country earn the right to enroll as taxpayers contributing to the system. Keep reading to learn more about Medicare.

11 facts about Medicare
Medicare is administered by the Centers for Medicare and Medicaid Services (CMS), a division of the U.S. Department of Health and Human Services (HHS). Usually, Medicare benefits can vary depending on the enrollment plan chosen by the beneficiary. It includes four enrollment plan options – Part A, Part B, Part C, and Part D. But there are many important facts one must know about the initiative before enrolling. Some key facts regarding the program are listed below.

Employees and employers contribute money toward Medicare benefits
In most cases, the bulk of the money to provide Medicare benefits comes from employees and employers. It includes 1.45% of a worker’s wages, which adds up to 2.9% of the total amount. In the case of self-employment, the workers contribute 2.9% of their income towards the Medicare program.

Not every U.S citizen qualifies for Medicare benefits
A federal health insurance program, Medicare, and its benefits are provided to U.S. citizens aged 65 and above. However, young people with disabilities can also qualify for the program and its benefits. Furthermore, as a part of the rules and regulations, these people must have received social security disability benefits for 24 months or have a diagnosis that indicates their disability. It can include health conditions such as end-stage renal disease or amyotrophic lateral sclerosis.

Contributions can only be made towards Medicare or HSA, not both
Once an individual chooses to contribute towards Medicare, they can no longer contribute to a health savings account (HSA). However, one can continue to take tax-free distributions from their HSA to pay for healthcare-related expenses.

Different parts of Medicare help cover specific healthcare services
Although Medicare provides healthcare benefits to the beneficiaries, it comprises multiple parts covering different aspects of healthcare.

  • Medicare Part A covers inpatient care in hospitals, hospice care centers, and nursing facilities.
  • Medicare Part B may cover certain doctor services, treatment supplies, preventive services, and outpatient care.
  • Medicare Part D helps cover the expenses for prescription treatments.

However, one must remember that these benefits are not unlimited or premium free. Hence, the beneficiaries must make certain out-of-pocket expenses to cover the treatment expense.

There is a limited period to sign up for Medicare parts A&B
If one wishes to enroll as a beneficiary for Medicare parts A&B, they must do so in a seven-month period between three months before their 65th birthday, the birthday month, and three months after. If the individual misses the seven months window, they must pay a delayed enrolment penalty of 10% per year. However, if an individual is already taking the benefits of social security, then they’re automatically enrolled in Medicare parts A and B.

Working longer is considered a valid reason to skip enrolling for Medicare at age 65
In most cases, if an individual or their spouse is covered by group health insurance through an employer or union, they can delay their enrollment in Medicare without worrying about the penalty. So, after the treatment coverage ends for the individual or their spouse, they have eight months to sign up for Medicare and its benefits. This period is known as the special enrollment period (SEP).

Medicare does not cover all kinds of healthcare services
As a part of the federal program, Medicare is designed to provide the expenses of hospital, rehabilitative, and healthcare. Hence, beneficiaries cannot pay for custodial or long-term care using any part of Medicare. Besides, Medicare usually does not cover certain healthcare services opted for by seniors. It can include eye exams, dental care, eyeglasses, dentures, routine foot care, and hearing aids.

Medicare does not cover healthcare services opted outside the United States
In most circumstances, Medicare cannot be used to pay for healthcare or supplies outside the country. It includes the 50 states, the District of Columbia, American Samoa, the U.S. Virgin Islands, Guam, and the Northern Mariana Islands. However, if one wishes to opt for healthcare benefits while traveling abroad, they can choose Medicare supplement insurance known as Medigap and its policies to cover their treatment expenses.

Not all parts of Medicare are free of cost
While Medicare Part A, which covers an individual’s hospitalization expenses, is free of cost, one must have paid Medicare taxes for ten or more years while working. The other parts of the Medicare program, such as Medicare Part B, require all enrollees to pay a fixed amount of $164.90 as a premium every month. Furthermore, in the case of Medicare Part D, the federal program may cover some of the treatment expenses. However, this is limited to 80% of the cost; the beneficiary must pay the remaining.

Seniors will not automatically be enrolled in the benefits of Medicare part C and D
As Medicare Parts C and D are not included in the Original Medicare coverage, the beneficiaries will not be enrolled for the benefits under these parts of the program. Medicare Part C is a private insurance opportunity that encompasses expenses not covered by the other parts of the program. It includes healthcare services such as dental and vision. However, the costs can vary from one Medicare Advantage plan to another.

Medicare does not cover nursing home stays
Medicare part A, which covers hospitalization, may help pay for certified skilled nursing facilities. However, Medicare does not cover custodial care and services such as bathing, dressing, eating, and other personal care provided at nursing homes.

Medicare provides benefits to millions of U.S. citizens each year. However, one must plan early to understand the benefits of this federal program.