What Are The Medicare Benefits for Seniors: How Older Adults Can Get the Most Out of Their Medicare Health Insurance Program
If you are age 65 or older, Medicare is a significant player in your medical insurance coverage. This government-run social program provides health insurance to retired people who qualify for Medicare.
Medicare covers many benefits that can help older adults live healthier lives. These benefits include coverage for prescription medications, hospital stays, Access to doctors, and other healthcare services.
If you want to join a Medicare Advantage plan or Medigap Plan G, keep reading to learn more about your Medicare benefits and how to sign up for Medicare.
Table of Contents
What is the list of Medicare Benefits for Seniors?
1. Medicare provides health insurance options to Seniors
The Centers for Medicare and Medicaid is a government-run health insurance program that provides coverage to seniors and other eligible individuals. There are four parts to Medicare: Part A covers hospital expenses, Part B covers doctor visits and other outpatient care, Part C is a private health plan option, and Part D covers prescription drugs.
Medicare Beneficiaries can choose which parts of Medicare they would like to enroll in and purchase Medicare Supplemental insurance plans to cover expenses not covered by Original Medicare.
2. Medicare Part D provides prescription drugs to older adults
Medicare prescription drug plans offer Part D benefits through private insurance companies, differ on which drugs are covered, and have different pricing options. Working with a licensed Medicare insurance agent with access to multiple Medicare-approved insurance companies to compare your plan options is best.
3. Medicare Part A provides hospital insurance and medical care options to older adults
Most Medicare beneficiaries are automatically enrolled in Medicare Part A, which covers a range of services, including inpatient hospital care and skilled nursing facility care. You are also covered for hospice care if the provider certifies you need it.
4. Medicare Part B provides health care services for doctors visits, outpatient care, home health care, durable medical equipment, and more
Medicare Part B offers a range of outpatient and medical services that can be helpful for older adults. These benefits include DME, home health aide services, and ambulance transportation.
Medicare Part B also offers preventive services like screenings, counseling, and therapy. Some prescription drugs are covered through Medicare Part B when administered by a doctor, and seniors may have to pay 20% of the cost-sharing for these drugs.
What are the Different Parts of Medicare Health care Coverage Seniors can Apply For?
Medicare Parts A
Medicare Part A is included at no cost if a person has worked 40 or more quarters of Medicare-covered employment. If you or your significant other has worked 10 full years, the Part A premium is $0 per month.
Most Medicare beneficiaries receive automatic enrollment in Medicare Part A at age 65, while others must undertake specific measures to sign up for Medicare Parts A & B.
Services covered by Medicare Part A include the following:
- Inpatient care
- Skilled nursing care
- Hospice care
- Acute care
- Home health care
- Assisted living facilities
- Durable medical equipment
- Ambulance services
- Physical and occupational therapies
- Speech-language pathology
- Hospital meals
- Drugs needed during inpatient treatment
- Other hospital services and supplies as part of inpatient treatment.
Medicare Part B
Medicare Part B is a critical healthcare benefit that can not be missed and may include lifetime late enrollment penalties. When a Medicare beneficiary becomes eligible for Medicare Part B, sign up to avoid these lifetime fees.
Part B of Medicare will cover the following services:
- Doctors and other healthcare providers’ services
- Outpatient care
- Durable medical equipment
- Home health care
- Preventive services
- Cancer-fighting treatment
- Annual wellness visits
- Ambulance transportation
- Assisted living facilities
Medicare Part C: Medicare Advantage plans
If Medicare Advantage plans (also known as Part C) are available in your area, you can sign up for one of these health insurance plans offered by private insurers that contract with Medicare. These plans must provide the same benefits as Original Medicare (Parts A and B).
Many Medicare Advantage plans also may provide additional benefits, such as prescription drugs, routine dental and vision care, and/or wellness programs. Some Medicare Advantage plans also have lower costs than Original Medicare.
Millions of individuals nationwide have left Original Medicare and joined Medicare Advantage plans from California to New York. When you sign up for a Medicare Advantage plan, you give up and transfer your Medicare Part A & B rights to the private insurance company.
Medicare Part D Prescription Drug Plans (PDPs)
Medicare offers prescription drug coverage through the Medicare Part D plan. Medicare beneficiaries can choose from several different plans, which vary in coverage and price.
With the cost of health care rapidly rising, signing up for a Medicare drug plan is essential. The vast majority of Medicare beneficiaries sign up for this voluntary prescription drug program to avoid paying a Part D penalty that will remain forever.
Medicare Supplement Plans (Secondary Insurance to Original Medicare Health Benefits)
Different types of Medicare Supplement Plans are available, and each plan is designed to cover various costs associated with Original Medicare. The most popular programs include Medicare Supplement Plan G, which covers all costs minus the Part B deductible, and Plan N, which covers some of the gaps in Original Medicare coverage.
What's Not Covered by Medicare Coverage Part A & Part B
Medicare does not cover everything. Some services and items are never covered by Medicare, which can limit people’s access to care. People with limited income or resources may be able to get help paying for these costs through other government programs and nonprofit organizations.
Medicare does not cover dental care and dentures (with a few exceptions), eyeglasses, long-term care, hearing aids, and physical exams (routine or yearly). Original Medicare does not cover prescription drugs except for hospice care and inpatient hospitalization.
Contact one of our Medicare insurance brokers, and we will explain how Medicare works once you receive your Medicare card in the mail.
What are the Steps to Enroll in Original Medicare Health Plan Part A and B?
Step 1: Determine if you are eligible for Medicare.
Those eligible for Medicare must be U.S. citizens or lawfully admitted aliens, have lived in the U.S. for at least five years, be disabled for over 24 months, or have been diagnosed with end-stage renal disease or ALS. If you are eligible for Medicare but not receiving Social Security retirement benefits, you can sign up during one of the three enrollment periods:
- The Initial Enrollment Period (IEP)
- The effective date of Medicare coverage
- The Special Enrollment Period (SEP) If you miss your IEP or SEP
Step 2: Choose the type of Medicare plan that you want.
You can choose from several different types of Medicare plans. Each plan has various benefits and costs. You must decide which plan is best based on your needs and budget.
Step 3: Decide if a Medicare Supplemental Plan or Medicare Advantage Plan is your Best Option
There are two main types of Medicare plans: Medicare Advantage Plans and Medicare Supplement Plans. Both have pros and cons, so deciding which is right for you is essential.
Private insurance companies run Medicare Advantage Plans, covering everything that Original Medicare (Parts A and B) covers. Many Medicare Advantage Plans also cover prescription drugs (Part D). Some plans might offer extra benefits, like routine vision or basic dental care.
The downside of Medicare Advantage Plans is that they can be more expensive than Supplement Plans. They also might have more limited networks of doctors and hospitals that you can see.
Medicare Supplement Plans may not include some of the additional benefits included with Medicare Advantage Plans, like a free gym membership. Still, they can help pay for some or all of the out-of-pocket costs that Original Medicare doesn’t cover, like deductibles, copayments, and coinsurance.
Medicare Supplement Plans are a good option if you want to keep your doctor or you’re concerned about being able to see the specialist you need.
Step 3: Enroll in a Medicare plan with the help of a licensed Medicare Insurance Agent
A licensed Medicare Agent can help you determine which Medicare plan is right for you and help you enroll once you are eligible for Medicare at age 65 or have a qualified disability. He or she will also be able to answer any questions about Medicare and help you understand how the program works.
Before enrolling in Medicare, discuss your needs with a certified Medicare agent.
Step 4: Start using your Medicare benefits.
Now that you have enrolled in your new Medicare plan, now is the time to see a doctor. Depending on the plan selected, you may be required to see specific doctors and medical facilities.
Members of a Medicare Advantage plan, ensure your doctors are covered in your HMO plan, or you will be responsible for the total cost.
Medicare beneficiaries enrolled in a Medigap plan do not need to be concerned with networks. As long as their doctor accepts Medicare (98% of doctors do take Medicare), they are free to make an appointment.
What is the Process of Choosing a Medicare Plan?
Step 1: Research the different types of Medicare plans
Various Medicare plans are available, depending on your budget and healthcare needs. You can research different types of Medicare plans by looking at prices, coverage, and other factors.
Reach out to an independent Medicare insurance agent like Integrity Now Insurance Brokers, so they can help you research all available health insurance plans from every insurance company that offers Medicare.
Step 2: Compare Medicare plans
If you are looking for the best Medicare plan for your needs, it is essential to compare all available options. It is important to consider your premium and deductible before selecting a plan.
Some plans have their premiums, co-pays, and other costs. It is important to compare all these factors before making a decision.
Step 3: Choose a plan
Now that you have compared several plans, if you are enrolled in Medicare Part A and Part B, you can move forward with the plan selected.
Step 4: Enroll in a plan
Your Medicare insurance agent will ask for your Medicare card to obtain the needed information to enroll in the plan selected. They will complete the application and request your review and signature.
How can I Save Money on my Medicare Enrollment Costs?
Know the cost-sharing rules
There are four ways to share the cost of Medicare: premium, deductible, co-pay, and out-of-pocket maximum. The deductible is fixed yearly, while the co-pay and out-of-pocket maximum varies by part (A, B, or D).
There are several different types of premiums: Medicare Part A (is usually zero), Medicare Parts B and Part D, Medicare Part C (may or may not include a monthly premium, and Medicare Supplement Plans.
Shop around for Medicare plans by using an independent Medicare insurance broker
If you’re looking for a Medicare plan that offers the coverage you need and fits your budget, you can shop around for options. You can find plans in your area from several different carriers. You may also want to consider a Medigap policy to supplement your Medicare coverage.
Explore Medicare Advantage plan and Costs
While these plans typically have lower premiums, they may have higher out-of-pocket costs than traditional Medicare with a Medigap policy. Medicare Advantage plans can be less expensive for healthy individuals who do not use their health benefits.
It is critical to remember that Medicare Advantage plans include network access restrictions, have referral requirements, including carrier prior authorization, and can implement Medicare Part B step therapy requirements.
Explore Medicare Supplement Plan (Medigap plan) and their Health Insurance Premiums
Medigap plans offer a variety of benefits not included in Original Medicare. By comparison, Original Medicare provides few protections for budget-minded seniors.
For example, Medigap policies help protect your finances and can provide peace of mind by providing additional coverage should you need it. Medicare beneficiaries know what to expect with their Medigap plans from year to year as they are standardized insurance plans that never change.
Sign up for an affordable Medicare Prescription Drug Coverage Plan
Not everyone needs the top-of-the-line Part D plan. If you are not taking prescription medication, sign up for the most cost-effective Part D plan. If your situation changes, our insurance agents specializing in Medicare can help you upgrade your plan during the next open enrollment period.
What Does it Mean to be Dual Eligible?
Dual eligible means having both Medicare and Medicaid coverage at the same time. This can happen if you are eligible for both programs or have Medicare, are also low-income, and qualify for Medicaid.
What is Medicare & State Health Insurance Assistance Program (SHIP)
Medicare is a government-run health insurance program for people over the age of 65. SHIP is a helpline that provides information and assistance with Medicare. SHIP also offers a locator service to help older adults find their nearest SHIP office.
Can I Combine Medicare and Veteran's Benefits
Yes, Veterans can combine their Medicare and Veteran healthcare benefits to get the most out of their benefits.
Medicare Costs and Premiums
Medicare Part A Costs
If you are not eligible for the premium-free version of Medicare, you must pay a monthly premium. Your Medicare Part A premium will be based n the number of quarters you worked.
If you paid Medicare taxes while working, you usually don’t have to pay a monthly premium for Part A coverage. You may have to pay a higher premium if you don’t enroll in Part A when you’re first eligible.
If you don’t buy Part A when you’re first eligible, your premiums will increase by 10%. The number of years you could have had Part A but didn’t enroll is called a “late penalty.”
Medicare Part B Costs
The monthly premium for Medicare Part B for 2023 is $164.90. This amount can increase if you are considered a high-income earner or enrolled in Part B late.
Medicare Part C Costs
Medicare Part C costs and premiums vary depending on an individual’s plan. Many Medicare Advantage plans do not charge an additional monthly premium, whereas others will.
Medicare Part D Costs
The costs and premiums for Medicare Part D can vary based on your chosen plan and your prescription drug needs. The average Part D monthly premium for 2023 is 31.50.
Medicare Supplement Insurance Costs
If you have Original Medicare, purchasing a Medicare supplement insurance policy is recommended to help offset costs. Medigap plan costs are based on the level of coverage, location, and age.
Dental, Vision, and Hearing Insurance Costs
Older adults should be aware of Medicare’s limited benefits in terms of dental, vision, and hearing services. It is recommended to obtain an outside PPO dental plan that includes additional coverages for vision and hearing aids.
Long-Term Care (LTC) Insurance Costs
It’s important to remember that Medicare only pays for limited and medically essential skilled treatment. This means you may have to pay some of the costs yourself, such as premiums and out-of-pocket expenses for long-term care.
Talk with one of our licensed insurance agents about LTC before turning 65. Many companies have stopped offering LTC policies past age 65.
I am Receiving Social Security Benefits Should I Be Concerned About My Medicare Benefits?
If you already receive Social Security benefits when you turn 65, you will automatically be eligible for some parts of Medicare and may not have to do anything.
You should check with your local Social Security office or visit the official website to determine if and when you need to enroll in additional coverage.
Should I Protect My Retirement Income with an Annuity?
Fixed annuities offer many benefits, making them a good option for older adults. These annuities protect your retirement savings against market volatility, offer a guaranteed interest rate, and can provide more potential earnings over time if the stock market performs well.
- Fixed annuity: A fixed annuity protects your retirement money from market volatility.
- Provides a guaranteed interest rate: With a fixed or fixed index annuity, you will earn a guaranteed interest rate on your money, no matter what happens in the stock market.
- Fixed index annuities protect your money from stock market losses: The interest rate is set when you purchase the annuity and does not fluctuate based on the stock market.
- Your money is “locked in” even if the future value of stocks decreases: Interest earned is “locked in” even if the future value of stocks decreases.
- If you don’t protect your retirement savings, it could result in losing everything: Fixed-indexed annuities ensure your retirement income will not decrease with stock market losses.
- Fixed or fixed index annuities offer protection from inflation: These annuities protect your retirement savings against inflation.
Our team can help you find the right annuity that fits your needs and protects your retirement savings.
What are Medicare benefits?
If you are considering Medicare for the first time, it is essential to understand all of your benefits.
Medicare benefits include healthcare coverage options, and some Medicare Advantage plans include additional benefits such as a flex card for seniors. Many different health insurance plans are tailored to seniors, so it is critical to talk with one of our Medicare insurance brokers for help.
What are the eligibility requirements for Medicare?
Here is the eligibility requirement for Medicare
- An individual must be 65 years or older
- Been disabled for over 24 months
- Been diagnosed with end-stage renal disease
- Diagnosed with Amyotrophic lateral sclerosis (ALS) is commonly known as “Lou Gehrig’s disease,”
- A U.S. Citizen or a permanent legal resident for at least five years.
How do I enroll in Medicare?
You can enroll by submitting an online application, over the phone, or in person at your local Social Security office. The easiest way to enroll is online.
What is the difference between Medicare and Medicaid?
Medicare is a federal health insurance program for people 65 or older or with specific disabilities. Medicaid is a state and federal health insurance program for low-income people.
How Do Medigap Plans Work with Original Medicare?
Medigap plans are secondary insurance policies that work with Original Medicare, so you don’t have to worry about coverage gaps. They do not replace Original Medicare like Medicare Advantage plans.
What is the difference between Original Medicare and Medicare Advantage Plans?
Original Medicare is a federal health insurance program that covers hospital and medical expenses for seniors and people with specific disabilities. Medicare Advantage Plans are private health insurance plans approved by Medicare and may offer additional benefits beyond Original Medicare.
What are the benefits of enrolling in a Medicare Advantage plan?
There are several benefits to enrolling in a Medicare Advantage plan. These plans can offer enrollees a wide range of coverage, including prescription drug coverage, routine check-ups and screenings, and hospitalization.
In addition, Medicare Advantage plans must include max out-of-pocket costs as part of each plan. This can make them a good option for people with a fixed income or limited financial resources.
How do I choose the right Medicare Plan for Me?
There are a few things to consider when choosing the right Medicare plan. First, consider your healthcare needs and what kind of coverage you seek.
Then, compare the plans with our licensed Medicare agents to see which best meets your needs. Be sure to read the fine print and understand the terms and conditions of each plan before making a decision.
Lastly, don’t be afraid to ask for help from a Medicare representative if you’re having trouble choosing the right plan.
What Are Social Security Disability Benefits?
Social Security Disability Benefits is financial assistance provided to individuals who cannot work due to a disability or severe medical condition. This program is overseen by the Social Security Administration (SSA) and is designed to provide financial support to those who cannot financially support themselves.
To be eligible for Social Security Disability Benefits, an applicant must have a medical condition that prevents them from engaging in substantial gainful activity. It is expected to last at least 12 months or result in death.
Applicants must also have sufficient social security credits to qualify for the program. The amount of financial assistance received through Social Security Disability Benefits varies depending on the individual’s work history and the severity of their disability.
Integrity Now Insurance Brokers is Here to Help you Get Medicare Coverage
Integrity Now Insurance Brokers is here to help you get the Medicare coverage you need. We are an independent insurance broker specializing in Medigap plans.
We work with all the major carriers in the Medicare market, so we can find a plan that fits your needs and budget. We’re here to help you navigate the Medicare system and find the coverage you need.
Call us today, and let us help you get the necessary coverage.