Chelsey Tucker graduated with a Bachelor of History degree from Metropolitan State University in 2019. She now writes about insurance with her specialty being life insurance and has been quoted on Help Smart Phone and MEL Magazine.

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Dan Walker graduated with a BS in Administrative Management in 2005 and has been working in his family’s insurance agency, FCI Agency, for 15 years. He is licensed as an agent to write property and casualty insurance, including home, auto, umbrella, and dwelling fire insurance. He’s also been featured on sites like Reviews.com.

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Reviewed by Daniel Walker
Licensed Auto Insurance Agent

UPDATED: Mar 19, 2020

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Medicare: A Comprehensive Guide

Medicare is one of those insurance programs that leave people scratching their heads and thinking, what in the world is that about!

There are several Medicare options and a couple of different ways to purchase Medicare. You can purchase Medicare through the government, or you can buy it through a private insurer, who works on behalf of the government.

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The benefit of buying coverage through a private insurance company is that you have more options and you may even be able to get more competitive pricing for your Medicare coverage.

However, with a low price tag of about $35 to $110 a month, depending on your income, you aren’t going to be paying a lot for your traditional Medicare coverage anyway.

Traditional Medicare covers both Part A and Part B; however, if you have other health insurance available to you, you can choose to purchase only Part A or only Part B. In addition, there are no income requirements to qualify for Medicare, although if you make more than $88,000 a year, your premiums will increase.

What is Medicare?

Medicare is a government sponsored, fee for service plan. This means that you can go to any doctor or hospital that accepts Medicare for your services, giving you a lot of flexibility when you need medical care. This plan isn’t like Medicaid; your doctor will be paid for the services that he/she provides, not for a set amount of dollars.

Part A of your Medicare coverage pays for your hospital benefits. If you qualify, you can receive Part A without having to pay any premiums. In order to qualify for the no premium option you have to be:

  • 65 years of age
  • Collecting social security or
  • Eligible for social security

Part B of your Medicare coverage pays for pretty much all of your other medical care. There are some exclusions for your care that you have to pay out of pocket for such as:

  • Physicals
  • Custodial care
  • Hearing aids
  • Foot care

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There are some gap type Medicare insurance that you can purchase, but many experts don’t recommend buying them because the cost isn’t worth the value you receive by purchasing them.

You can also purchase what Medicare calls Medicare Advantage Care plans. These plans are called:

  • Health Maintenance Organizations (HMO),
  • Preferred Provider Organizations (PPO)
  • Medicare Medical Savings Account Plans (MSA)

You can also purchase a Medicare prescription plan.

You have to choose between the original Medicare plan, the HMO or the PPO, you cannot choose all three. If, however, you want to switch plans, you can do so at the beginning of each new year, much like you would for any other kind of insurance.

HMOs and PPOs, which are Medicaid Part C plans, both work virtually the same way as these insurances do when you purchase private insurance.

  • Health Maintenance Organization (HMO): When you choose the HMO, you have to choose your care and services from a network of doctors and hospitals. If you go outside of the network, then you pay for your services out of pocket.
  • Preferred Provider Organization (PPO): A PPO offers more flexibility, meaning that if you choose from the network of doctors, then you pay your standard copay and leave it at that. If, however, you want to see a doctor outside of your network, you still can, you just have to pay the difference between your coverage amount and what that doctor charges.
  • Medical Savings Account (MSA): The MSA plan is a high deductible plan that allows you to keep your premiums very low. You pay for your own medical care until your deductible is met. In the meantime, Medicare places an agreed upon amount of money into a medical savings account for you. This account draws interest and the money carries over any year you don’t use it. This money can be use to pay medical bills or purchase prescriptions.

The Medicare prescription plan is just that, a plan that helps you purchase prescriptions. If you take a lot of medication, then this plan is going to be important for you, and it’s very affordable. Like with most health insurance companies, if a generic form of your medication exists, you will have to purchase that before you can get a name brand medication.

If you are a low income person, you can get Medicare Part A and then combine it with Medicaid, if you qualify. This combination will usually provide you with every type of coverage that you will need during your twilight years.

All of these plans aren’t available in every state, which can be frustrating. However, every year more and more areas have access to the full line of Medicare options that are available.

It is important to note that if you travel outside of the US, Medicare will not cover your medical costs. When you travel outside of the country, make sure you purchase travel medical insurance to ensure that your medical needs are taken care of if anything should happen.

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When can I enroll in Medicare?

As mentioned before, you won’t qualify for Medicare until you are 65 years old and you are collecting or are eligible to collect social security benefits. You can enroll in Medicare 3 months before you turn 65. After you turn 65, you have 7 more months to enroll, for a 10 month total before you have to wait for the new year to enroll.

If you wait to enroll, you may face a penalty of up to 10% for every year you don’t enroll. The exception is if you are still working and are receiving health insurance through your employer, then there are no penalties if you wait.

In addition, every year that you delay buying Medicare, your insurance rates will increase; this is beyond the possible 10% penalty. This happens even if you are getting health insurance from somewhere else.

How do I find out what Medicare Options are available in my area?

The easiest way to determine what Medicare options are available in your area is to use a quote tool to find private insurers that provide Medicare in your city or state. You can purchase traditional Medicare no matter where you live; however, the Medicare Advantage Plans may only be available in limited areas at this time.

With the 2010 health care bill, there are going to be some changes to Medicare because of cuts in government health plans. You can learn more about these cuts and other ways that the health care bill will affect your Medicare coverage by visiting the Kaiser Foundation site.

Medicare can be confusing and every time a change is made, which seems to occur almost annually, more confusion occurs. However, you can keep things simple by sticking with the original Medicare coverage, which is the easiest to understand. You shouldn’t allow this to limit you, however, and you should take advantage of some of the additional benefits that other coverage types have to offer.

You can call your social security office if you have any questions or if you want to enroll, or you can enroll online. If you want to compare rates between private insurers, enter your zip code now and we will get you started.

Try it today and see what Medicare has to offer you! Don’t qualify for Medicare? No worries, our quote tool can help you find an affordable health care plan today! Enter your zip code to get free online health insurance quotes now!