When asking people to describe Medicare or Medicaid, most people are at best not sure and at worst confused. Let’s start with Medicare. It’s a federal insurance program available for most people over 65 regardless of income, younger people with disabilities, and dialysis patients. Medicaid is an assistance program. It serves low-income people of all ages. Read on to see which program might work for you.
Medicaid is an assistance program. It serves low-income people of all ages. Patients usually pay no part of the costs for covered medical expenses. A small co-payment is sometimes required. Medicaid is a federal-state program that varies from state to state and is run by state and local governments within federal guidelines. In Oregon, it’s known as the Oregon Health Plan (OHP). If you are under age 65 and don’t have Medicare, you may qualify for OHP. The Council on Aging does not handle OHP, but you can learn how to apply here.
What are the different parts of Medicare?
- Hospital insurance with Medicare Part A covers inpatient and inpatient care in a skilled nursing facility, hospice care, and home health services. There is usually no monthly premium for coverage under Medicare Part A.
- Medical insurance with Medicare Part B covers physician services, outpatient care, durable medical equipment, and many preventive services. Most people must pay a monthly premium of $170.10 for Medicare Part B.
- Medicare Advantage Plan with Medicare Part C is a group of Medicare-approved private insurance companies that charge a premium to cover Part A and Part B services. It may even offer prescription drug coverage and other supplemental benefits. You cannot purchase a Medicare Advantage Plan without paying the Part B premium of $170.10.
- Prescription Drug Plan with Medicare Part D is a group of Medicare-approved private companies that provide prescription drug coverage on an outpatient basis.
Why Consider Medicare Advantage Plans?
Medicare doesn’t cover everything, including hearing aids, podiatry, dental and vision care, and nursing home care. People enroll in a Medicare Advantage plan instead of traditional Medicare to possibly increase coverage for additional healthcare needs.
Medicare Advantage plans, offered through Medicare Part C, allow private insurers to offer alternatives to traditional Medicare. These plans must cover everything covered by Parts A and B. Medicare pays these plans a set amount per enrollee roughly equivalent to the value of Parts A and B coverage. You pay an additional cost for expanded coverage.
Medicare Advantage plans are increasing in popularity. In 2021, more than 26 million people enrolled in a Medicare Advantage plan, accounting for 42 percent of the total Medicare population and $343 billion (or 46%) of total federal Medicare spending.
What Are Medigap Plans?
Some enrollees choose to pay for additional private insurance called a Medigap plan. It helps reduce out-of-pocket costs in the event of a severe medical condition. Since Medigap plans do not cover prescription drugs, people who want that coverage must purchase a separate prescription drug plan.
Medicare Part B has a 20% co-pay for all physician and equipment costs. Medicare Part A reduces coverage for hospital stays after 60 days. This means that in the event of a serious health condition, you could face high out-of-pocket costs. In addition, there is no cap on out-of-pocket spending under traditional Medicare. Medigap insurance pays for many extra expenses in the event of a significant health condition.
Long Term Care Insurance covers in-home and long-term care for routine daily activities like eating, dressing, bathing, and getting in and out of bed. Paying for private LTCI ensures you can cover the high cost of personalized care down the road. Costs vary depending on the policy.
When is the Medicare enrollment timeline?
The initial enrollment period for Medicare is a 7-month period surrounding your 65th birth month, the 3 months before your 65th birth month; the month of your 65th birthday; and the three months following your 65th birth month. Failure to apply during this 7-month period could result in premium penalties.
Medicare Advantage Plans and stand-alone Prescription Drug plans can be changed annually during the open enrollment period, which runs from October 15th until December 7th. Coverage starts on January 1st of the following year. Medigap plans can be changed every year during your birthday month.
How can you enroll in Medicare?
- Online is the easiest way. Sign up for Medicare at socialsecurity.gov.
- Call Social Security at 1-800-772-1213. TTY users can call 1-800-325-0778
- Contact your local Social Security office
Choosing the Right Path Can Be Confusing – Council on Aging SHIBA Counselors Can Help
Because there are so many questions about Medicare coverage, making an appointment and getting answers from expert Council on Aging volunteer counselors may be beneficial. These volunteers are all trained and certified by the Oregon Senior Health Insurance Benefits Assistance (SHIBA) program.
Volunteer SHIBA counselors do not recommend one plan over another. They help you assess the best healthcare choices for you. They provide objective, unbiased information, answer general Medicare questions, and help people understand available insurance options and whether they qualify for income-related benefits.
SHIBA Counseling Appointments Are Free
The best time to get Medicare advice is before turning 65 years old. Even if you plan on delaying Social Security benefits, you still need to know about Medicare to avoid penalties.
We can help you understand your Medicare benefits, identify and compare health insurance options, and protect you from paying too much for medical care and prescription drugs.