Basic Medicare Facts

Basic Medicare Facts You Need to Know

Are you new to Medicare? Are you turning 65? This article will highlight 7 great points about Medicare. 

If you’ve had employer or private health insurance, you might be nervous about moving to Medicare.  Many people worry that Medicare won’t provide the same level of care. Those worries are usually short lived once you realize there’s a lot to like about Medicare.   Especially if you had health insurance through the Affordable Care Act.  You may be pleasantly surprised with lower Medicare costs. If you’re just now getting Part B, or turning 65, here’s some of the key features about Medicare coverage.

1.  Medicare is a successful program

Medicare turned 50 years old in 2015.  It’s one of the nation’s most popular programs.  Before Medicare was signed into law, only fifty percent of seniors had health insurance. Leaving many seniors financially vulnerable.

Medicare’s program is guaranteed health insurance for those who’ve paid into the system.  Current income and health status do not matter.  

Medicare has proven the test of time. Nearly all Americans over the age of 65 have health coverage thanks to Medicare. With life expectancy increasing, Medicare continues to be a valuable program for seniors.

2.  Medicare has a huge network of providers

The majority of doctors are network participants. There are more than 800,000 healthcare providers available to you.  Medicare’s network is actually bigger than other insurance provider networks. 

Some Medicare recipients fear that doctors will drop out of the Medicare program. However, less than one percent of doctors have stopped seeing Medicare patients.  According to a 2013 report from the Kaiser Family Foundation, 96 percent of Medicare beneficiaries were able to see a doctor.

Even if you move to a new area, you should not have to worry about finding a provider. That is not always the case for anyone who uses a Medicare Advantage plan, known as Part C.  

Medicare Advantage participants can’t use Medicare Part A and Part B.  This means they must use the network of doctors participating in the Advantage Plan.  If you live in a rural area, Medicare Advantage Plans may not have many providers in network.  Having Original Medicare Part A and B allows you access to any Medicare doctor in or out of your area. People who live near state lines can easily visit a provider in the neighboring state.

Medicare’s Physician Comparison tool  helps you locate providers in your area.

3.  Medicare has providers around the nation

When people retire, they often travel or live in multiple cities or states. Since Original Medicare is a nation wide program, beneficiaries can visit doctors anywhere in the United States.  

If you have Medicare Supplement insurance, it will also be accepted regardless of where you are in the US.  

In contrast, Medicare Advantage Plans tend to have small local networks.  This means the care you get outside the area may not be covered. Don’t get involved in a Medicare Advantage plan without understanding what is and is not covered while traveling.

4.  Medicare doesn’t require a referral

With traditional Medicare A and B, you’re allowed to see any provider who accepts Medicare without a referral.  In contrast, an HMO Medicare Advantage plan will often require a referral from your primary doctor.

Certain Medicare services do require prior approval before Medicare will pay the Claim.  However, you still get to choose your own Medicare provider.  And, if an illness is serious, you can see more than one specialist.

5.  Medicare with Medigap provides complete coverage

Another reason why you’ll want Original Medicare is the supplemental coverage.  Because Medicare Part A and Part B generally pay about 80% of healthcare costs, Medigap, also known as Medicare Supplement insurance, is a great tool for covering the gap that Medicare doesn’t pay.

If you choose to buy Medigap, you can use still use the vast network of Medicare providers.  That’s one of the great things about Medigap.  If the provider accepts Medicare, so does your Medigap insurance carrier.  This is not the case if you decide to convert Original Medicare to a Medicare Advantage Plan.  

Most people pair Medicare with either  Plan F, Plan G or Plan N.  

It’s important to note that beginning 2020, Plan F will no longer be for sale.  This is why Plans N and G are becoming more popular. If you’d like to read more, we reviewed Medicare Plan N vs G.

Congress is eliminating Medigap Plans with first dollar coverage (Plan F and Plan C).  If you buy Plan F or Plan C before 2020, you get to keep your plan.  If you choose to keep your Plan F or C after 2020, you must keep making  your Premium payments.  If you drop your Plan F or Plan C after 2020, you can’t get it back. 

6.  Medicare allows pre existing conditions

People who have a serious health condition often worry that transferring to Medicare means their pre-existing conditions will not be covered.  

That’s not the case.  When Medicare Part A and Part B become effective, you don’t have to wait for treatment. Your Medigap Plan will also cover your pre-existing conditions if you enrolled during your Medigap Open Enrollment Period.

Medigap Open Enrollment Period is a time frame that last six months. It begins the first day of the month when you are 65 or older and enrolled in Medicare Part B.

Example:  If you turn 65 on March 22 and you enroll in Part B to coincide with your 65th birthday, your Medigap Open Enrollment Period begins March 1.  However, if you turn 65 on March 22 but wait until April to get Part B, your Medigap Open Enrollment Period will begin on May 1.  This effective date is the first day of the month that you are BOTH 65 and enrolled in Part B.

7.  Medicare outlines benefits and continues to improve coverage

One of Medicare’s key strengths is its outline of coverage.  CMS regulates and sets rules for the Medicare program. Medicare must abide by the law and provide the minimum scope of benefits and clearly outline the out-of-pocket costs.

If Medicare beneficiaries meet certain requirements, they can be eligible for a range Part A and Part B services.  Beneficiaries can’t be charged more than the outlined deductibles, copays and Coinsurance.

Some examples of Medicare Part A benefits

• Hospital
• Skilled nursing facility
• Home health
• Hospice benefits

Some examples of Medicare Part B benefits

• Physician visits
• Lab tests
• Durable medical equipment

And in the last few years, Medicare has included new preventive care services:

• Diabetes screening
• Cardiovascular disease risk reduction visit
• Depression screening
• Colorectal cancer screening
• Obesity screening and counseling
• Lung cancer screening

It’s a good idea to consult the Guide to Medicare’s Preventive Services for service eligibility.   Some preventive care services require you to meet certain medical criteria.

For instance, to be covered for lung cancer screening you must meet all of the following:

• Age 55-77
• Current smoker or quit within the last 15 years.
• Have a tobacco smoking history of at least an average of one pack a day for 30 years.
• Obtain a written order for PCP or qualified non-physician practitioner.

Once you start using Medicare, you’ll probably compare it to your prior health insurance.  While Medicare has room for improvement, it’s good to know there are groups advocating for Medicare Beneficiaries.

The Center for Medicare Advocacy calls on a renewed commitment to enhance Medicare by including more benefits in the future.

Suggested benefits include:

• Part B prescription drug benefit
• Call for the best price on Medicare covered medications
• Adding dental, vision and hearing coverage
• Developing a benefit for long-term services and support
• Ensuring beneficiaries access to a fair and exact appeals system.

About REMEDIGAP

By working directly with REMEDIGAP you will have personal agents. We’re dedicated to help you throughout the entire process – from education, applying, and ongoing service. You may have many questions or none at all.  Either way, we’ll customize our approach based on your needs.  We make sure you’re getting the best value with your Medigap plan from year to year.

So what are you waiting for?  Just give us a call at 888-411-1329 or simply click on our quote form for free Medigap quotes.  It’s an easy way to see just what we can do for you!

Thank you for reading our article Basic Medicare Facts.  Please leave any comments below or email us your questions at service@remedigap.com.