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What you need to know about Medicare

Medicare Open Enrollment runs from October 15 – December 7

Clinical Social Worker Freda Wilkins portrait
Freda Wilkins, M.S.W., M. Div.

“I have a patient who probably could have enrolled in Medicare Part B a year or two ago,” said VCU Massey Cancer Center Clinical Social Worker Freda Wilkins, M.S.W., M. Div. “She enrolled in Part A because it was free but didn’t enroll in Part B because she figured she had in-hospital coverage. Unfortunately, she was afflicted with breast cancer, and since treatment is done an outpatient basis, much of her care wasn’t covered.”

There are many misconceptions like this in regard to Medicare coverage. We asked Wilkins what are the most important things people should know during this year’s Open Enrollment Period, which runs October 15—December 7, and summarized the information in the FAQ below.

What is Medicare?

Medicare is the federal health insurance program for:

  • People who are 65 or older.
  • People under 65 that:
    • Have been receiving Social Security Disability for 24 consecutive months;
    • Have end-stage renal disease; or
    • Have amyotrophic lateral sclerosis (ALS).

What are the various parts of Medicare and what do they cover?

Part A: Hospital insurance

  • Medicare Part A covers inpatient hospital care, including hospital stays, care in a skilled nursing facility, hospice care and some home health care.
  • While Part A covers hospital costs, outpatient procedures that do not involve a hospital stay are instead covered by Medicare Part B.
  • Most eligible people qualify for premium-free Medicare Part A. If you do not qualify, the standard premium for Medicare Part A is $422.

Part B: Medical insurance

  • Medicare Part B covers outpatient care, including specialist office visits, medical supplies, preventive services and ambulance transportation.
  • There is a $134 (or higher based on income) premium for Medicare Part B, automatically deducted from Social Security benefits.

Part C: Medicare Advantage Plans

  • Medicare Advantage Plans are privatized Medicare-approved health insurance plan options for individuals enrolled in original Medicare (parts A & B).
  • Medicare Part D offers optional prescription drug coverage to those covered under original Medicare (parts A & B).
  • Most Medicare Advantage Plans (Part C) include their own prescription drug coverage. If you are covered under a Medicare Advantage Plan (Part C) that includes prescription drug coverage and enroll in Part D, you will be disenrolled from Part C and returned to original Medicare.

Part D: Prescription drug coverage

How do I enroll in Medicare?

  • When you are first eligible for Medicare, you have a 7-month Initial Enrollment Period to sign up for Part A and/or B.
    • This period begins 3 months before you turn 65, includes the month you turn 65 and ends 3 months after the month you turn 65.
    • For example, if you turn 65 on May 13, enrollment begins February 13 and continues until August 13.
  • If you are collecting Social Security benefits at least 4 months before you turn 65, then you will automatically be enrolled for Parts A & B.
  • If you are not collecting Social Security benefits at least four months before you turn 65, then you will have to sign up through Social Security to get Parts A & B.
    • For most, Part A is premium-free.
    • Part B, however, has a $134 (or higher, depending on income) premium, automatically deducted from your Social Security benefit payments.
    • There is a 10 percent penalty to the premium for the duration of the plan if you miss the Initial Enrollment Period.
  • If you miss this initial enrollment period, you will have to wait until the Open Enrollment Period, which runs October 15 – December 7.

What if I am currently enrolled in Medicare but want to change my plan?

  • You may change your plan free of charge during the Open Enrollment Period, October 15 – December 7.
  • Yes, if you are eligible for both Medicaid and Medicare then you may benefit from both.

Am I eligible if I already benefit from Medicaid?

  • Yes, if you are eligible for both Medicaid and Medicare then you may benefit from both.

Am I eligible if I have preexisting conditions?

  • Yes, as long as you fulfill other conditions listed above.

What if I don’t want Medicare Part B?

  • If you have health coverage through an employer (either yourself or your spouse), then you may decide to delay Part B enrollment to avoid paying the premium.
  • Be aware that if you do not sign up during the Initial Enrollment Period, you may have to pay a late enrollment penalty for as long as you have Medicare.
  • If you choose not to enroll in Part B during the Initial Enrollment Period because you are already covered through an employer, then you have an 8-month Special Enrollment Period that begins the month employment ends, or benefits end, whichever happens first.
  • If you enroll during the Special Enrollment Period, you generally will not have to pay a late enrollment penalty.

Why would I use a Medicare Advantage Plan?

  • Medicare Advantage Plans are Medicare-approved private health plans that offer all A and B coverage and can offer additional benefits such as dental, vision and hearing services not available under original Medicare.
  • Most plans also include their own prescription drug plan.
  • You will still pay your Medicare Part B premium under Medicare Advantage.
  • Medicare Advantage also allows individuals to shop around to find the best fitting plan. Copayment and coinsurance amounts may vary between plans and some may require using certain providers for health care services.
  • Under Medicare Advantage, once a specific out-of-pocket expense limit is reached, members pay nothing for covered care costs. This threshold varies each year so it’s important to check plan details before you enroll.
  • If you wish to return to original Medicare or switch to a different plan, the Medicare Advantage Open Enrollment Period is from January 1 – March 31. This is only available for preexisting members.

 

Article written by Brandon Franklin, communications intern at VCU Massey Cancer Center

Written by: Massey Communications Office

Posted on: November 13, 2018

Category: Prevention & control