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July 19, 2021 16 min

Today on All Home Care Matters, we are going to be discussing Medicare. First, we will be talking about what Medicare is and how it differs from Medicaid and other insurances. Then, we’ll look into how you can apply and receive Medicare before moving on to talk about how Medicare can help you and your family.

 

If you’re ready to learn more about Medicare then let’s get started.

 

According to the Kaiser Family Foundation, Medicare is a federal health insurance program created in 1965 for people ages 65 and over, regardless of income, medical history, or health status. It was expanded in 1972 to cover certain people under age 65 who have a long-term disability. There are currently over 60 million people in the United States on Medicare.

 

In 1945, President Truman called for the creation of a national health insurance plan but was unsuccessful. President Kennedy also tried to create a similar plan, but he was also unsuccessful in his attempt. Finally, nearly twenty years later, President Johnson signed Medicare into existence. Former President Truman got to see his idea come to life and he got to play a major role in it when he and his wife Bess, were the first two Medicare beneficiaries.

 

During the first year, nineteen million Americans signed up to receive Medicare. Over the years, there have been many changes and additions to Medicare legislation. Just last year, regulations were added due to the Covid-19 pandemic. If you are interested in seeing what regulations were added or changed due to the pandemic, you can find a good overview on the Commonwealth Fund’s blog. You can find a link to the blog in our show notes for this episode. You can also visit medicare.gov for more information on the current and up-to-date regulations and stipulations on Medicare.

 

 

There are three parts of Medicare, Part A, Part B, and Part D. Medicare Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Medicare Part B covers certain doctor's services, outpatient care, medical supplies, and preventive services. Medicare Part C helps cover the cost of prescription drugs, including many recommended shots and vaccines. For more details on each of the individual parts of Medicare, visit medicare.gov.

 

 

Almost everyone over 65 is eligible for Medicare Part A and most do not have to pay a premium either. If you or your spouse are eligible for Social Security payments, you are likely eligible for Medicare Part A, as well. In order to not pay a premium, you must have paid payroll taxes for more than ten years. For those with disabilities that are under 65, generally, if you receive Social Security Disability Insurance, then you are eligible for Medicare. In 2016, 15 percent of Medicare beneficiaries were under 65 years old. There is, however, a two-year waiting period to get Medicare this way. But if you are diagnosed with Amyotrophic Lateral Sclerosis, also known as ALS, or end-stage renal disease, which is permanent kidney failure requiring dialysis or a transplant, there is no waiting period for Medicare eligibility.

 

Earlier, we told you about the three parts of Medicare, and you may have wondered why we didn’t include the fourth part for Part C. Part C does exist, but it is actually separate from Medicare… in a way. Medicare Part C is what is known as Medicare Advantage. Medicare Advantage is one of the options you have when deciding how to get your Medicare coverage. With Medicare Advantage, you enroll in a private health plan, such as a health maintenance organization, or you may be more familiar with it by the abbreviation HMO, or preferred provider organization, or also known as a PPO, and receive all Medicare-covered Part A and Part B benefits and typically also Part D benefits. Basically, it is an all-in-one coverage plan that bundles the original Medicare options.

 

President Clinton signed Medicare plus Choice into law in 1997 and it was updated and changed to Medicare Advantage in 2003. Since then, enrollment in Medicare Advantage has grown. Last year, more than 24 million beneficiaries enrolled in Medicare Advantage, and enrollment is expected to grow to 26 million this year.

 

If you are interested in pricing and Medicare plan options, please visit medicare.gov for more information.

 

Medicare and Medicaid often go hand in hand, but people tend to get them confused. Medicare is an insurance program, whereas Medicaid is an assistance program. Medicare is also a federal program, while Medicaid is run by state and local governments. With Medicare beneficiaries you usually have to be over the age of 65 to qualify, but there are no age restrictions with Medicaid. Medicaid provides Americans with free or low-cost health coverage to low-income people, families and children, pregnant women, the elderly, and people with disabilities. To see if you qualify for Medicaid, visit healthcare.gov.

 

If you are having trouble remembering which one is which, remember that Medicare provides care, or insurance plans, while Medicaid aids needy families. Now, we know that Medicaid is no longer just for people with low-income, but the majority of people using Medicaid do have low-incomes and remembering that is easier than trying to say Medicaid comes to the aid of low-income people, families and children, pregnant women, the elderly, and people with disabilities.

 

Medicare is a federally funded insurance that is open to almost everyone over the age of 65 and it is often more cost-efficient than private insurances. Private insurances, however, have more options and pay scales to choose from. Private insurances offer things that Medicare doesn’t, like dental, vision, and hearing. Oftentimes, you may be able to find a plan that will work with Medicare and use it to cover what Medicare will not.

 

 

When choosing a Medicare plan, medicare.gov suggests considering costs, coverage, your other coverage, prescription drugs, doctor and hospital choice, quality of care, and travel when deciding between what sort of coverage you need. You can find more information on what you should consider when choosing coverage at medicare.gov.

 

 

Cost is a big determining factor when choosing an insurance plan. If you are paying for insurance completely out-of-pocket Medicare is most likely the option for you. If your employer provides insurance for you, they may pay part or all of your monthly premium, even after retirement, but that all depends on your employer. They all differ, as they all have different private insurance companies and plans.

 

According to Medical News Today, the average monthly premiums for private insurance in 2019 cost families $20,576 per year, the cost for individuals $7,188 per year, and cost for families $6,015 per year after their employer covered part of the cost. Medicare Part A typically has no monthly premiums and Medicare Part B has a standard monthly premium of $148.50, resulting in $1,782 a year.

 

Private insurance is open to everyone, so if you do not meet the age requirement or one of the other stipulations for Medicare, private insurance is always an option.

 

If you are interested in signing up for Medicare, visit medicare.gov to start the process. If you are 65 and receiving Social Security, you may have already been automatically enrolled, so make sure you double-check before you try to sign up. There are also only certain times of the year that you can sign up for Medicare, just like with private insurance. Depending on when you are trying to sign up, you may have to wait for the next enrollment period.

 

Once you are enrolled in Medicare, there are a few things you should do right away. You can find a Welcome to Medicare checklist on medicare.gov or the links in our show notes if you would like to look at the full list. First, you need to decide what Medicare coverage you would like. You can choose from the Original Medicare or Medicare Advantage. If you choose the original Medicare, you can also choose additional coverage to go along with it. Next, you need to give Medicare permission to talk to someone you trust.

 

If you are getting Medicare for your loved one, you need to fill out the Authorization to Disclose Personal Health Information form so that Medicare can interact with you directly. Then, go online and create a Medicare account at medicare.gov. From here, you can manage your Medicare information anytime, create a list of your prescriptions, view your Original Medicare claims status, pay your Medicare premiums, and more. You can also print an official copy of your Medicare card if you need it. Make sure you tell your doctor about your new Medicare plan and if you have other insurance, make sure to let Medicare know, as well.

 

During the first year you have Medicare, you can schedule a free “Welcome to Medicare” preventive visit with your doctor. It includes a review of your medical and social history related to your health and counseling about preventive services that may be right for you. During your first year, you should also find out what your Medicare plan covers. You can find out by visiting medicare.gov/coverage or you can use their free app, What’s Covered.

 

If you are on Medicare and you have a limited income, you may qualify for financial help. Visit medicare.gov to see if you are eligible to get help paying your Medicare health and drug costs. You should also get into the habit of filing and checking on your claims to make sure you are not being charged for services you never received.

 

If you choose a Medicare Advantage plan and would like to change or add on to your plan, you can do that, but make sure you do it within the first three months. If you would like to add or remove drug coverage or switch to an original Medicare plan, as long as you do it within the first three months of having Medicare, you can do so with no penalties or waiting period. If you decide you want to change your plan after the first three months, you can still do that, but only during certain times. Medicare Advantage’s open enrollment is from January 1st through March 31st. During this period, you can switch from one Medicare Advantage plan to another, switch from Medicare Advantage to Original Medicare, or enroll in Medicare Advantage for the first time.

 

The annual open enrollment period for Medicare is in the fall from October 15th through December 7th. During this period, you can change or add to your Medicare plan or enroll in a new Medicare plan. Any changes you make to your coverage will begin on January 1st. There are a few other times you can add or change your Medicare coverage plan like if you reach the age of 65, you lose your insurance, or you move. For more information on Medicare enrollment, visit medicare.gov.

 

If you or your loved one have questions about Medicare and cannot or do not have access to the internet or a computer, you can call 1-800-MEDICARE, or 1-800-633-4227 at any time. If you have difficulties with hearing or speech, you can also call their TTY number, 1-877-486-2048.

 

If you or your loved one are struggling to understand Medicare and everything that comes with it, know that you are not alone. Many people don’t understand Medicare, which is one of the reasons we have decided on discussing Medicare today. With your State Health Insurance Assistance Program, otherwise known as SHIP, you can get free and personalized health insurance counseling. A trusted insurance agent or broker can also help you understand Medicare and help you go over the options provided to determine the best plan and coverage for you.

 

Before Medicare and Medicaid were created in 1965, roughly half of seniors were uninsured. Today, both programs cover nearly one-third of all Americans. Without Medicare and Medicaid, a significant number of Americans would be unable to afford the medical care they needed to stay healthy and productive. These programs have saved countless lives since being established. Without them, many seniors would not have been able to afford a stay in the hospital and most likely would have avoided going, even if meant refusing life-saving treatment.

 

Many seniors worry that their medical expenses will ultimately fall on their loved ones and end up refusing to seek medical help when they need it, but with Medicare, they can seek the help they need and not worry about the financial burden. According to Medicare.gov, Medicare covers 23 types of preventive services, including flu shots and diabetes screenings. Some of these services are free, and for others, you only have a small copayment or deductible to pay, depending on which plan you have.

 

Medicare can help you and your loved one by providing them with insurance that allows them to seek medical help, but also allows them, and you, peace of mind. If you haven’t already, join the millions of families that use Medicare to help ease some of the financial burdens that come with aging. Combined with private insurance, you can make sure your loved one is covered and never has to worry about their medical expenses. When neither you nor your loved one has to worry about the costs, you can enjoy spending time together and making memories with them.

 

If you have any questions about Medicare, please visit medicare.gov for more information. You can also talk to your insurance agent or broker. They should be able to help you go over your options and find the best coverage for yourself or your loved one. You can also visit Medicare on Facebook and Twitter. They post content regularly that you may find helpful.

 

We want to say thank you for joining us here at All Home Care Matters, All Home Care Matters is here for you and to help families as they navigate long-term care issues. Please visit us at allhomecarematters.com there is a private secure fillable form there where you can give us feedback, show ideas, or if you have questions. Every form is read and responded to. If you know someone is who could benefit from this episode and please make sure to share it with them.

 

Remember, you can listen to the show on any of your favorite podcast streaming platforms and watch the show on our YouTube channel and make sure to hit that subscribe button, so you'll never miss an episode. Next, on All Home Care Matters we are very excited to share with you that we have some very special guests who will be joining us over the next few episodes. Stay tuned you won’t want to miss these interviews!

 

 

Sources:

https://www.medicare.gov/what-medicare-covers/your-medicare-coverage-choices/whats-medicare

 

https://www.kff.org/medicare/issue-brief/an-overview-of-medicare/

 

https://assets.aarp.org/rgcenter/health/fs149_medicare.pdf

 

https://www.medicareresources.org/medicare-benefits/medicare-advantage/

 

https://www.hhs.gov/answers/medicare-and-medicaid/what-is-the-difference-between-medicare-medicaid/index.html

 

https://www.healthcare.gov/medicaid-chip/

 

https://www.medicalnewstoday.com/articles/is-medicare-better-than-private-insurance#what-private-insurers-offer

 

https://www.medicare.gov/media/9211

 

https://www.medicare.gov/blog/medicare-and-medicaid-keeping-americans-healthy-for-50-years

 

https://www.medicareresources.org/basic-medicare-information/brief-history-of-medicare/

 

https://www.medicare.gov/what-medicare-covers/your-medicare-coverage-choices/consider-these-7-things-when-choosing-coverage

 

 

 

 

 

 

 

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