Medicare and Medicaid. These two words are so much alike that many people get them confused. They are both government-sponsored health insurance programs, but that is where the similarities end. One of these programs is for adults 65 and older, while the other is for low-income individuals. It is important to understand the difference between the two, so when it is time to enroll in Medicare, you do not miss the opportunity and end up facing a penalty.
Medicare Part A and B will help pay for medical services including hospital insurance and medical insurance.
What is Medicare?
Medicare is a federally-funded program run by the federal government. It is funded by taxpayer dollars as well as by premiums that are paid by beneficiaries. It covers all adults 65 or older; unlike Medicaid, Medicare eligibility is not determined by your income. When you turn 65, you are eligible for Medicare coverage that is broken down into 2 parts: Part A and Part B.
Part A is hospital insurance that covers inpatient medical services and supplies. You can receive premium-free Part A as long as you or your spouse worked and paid Medicare taxes for at least 10 years.
Part B is medical insurance and covers outpatient medical services and supplies. It has monthly premiums that you must pay in order to receive coverage.
When You Can Enroll
You can enroll in Medicare during the 7 month window around your 65th birthday, which includes the 3 months before your birth month, the month of your birth date, and the 3 months after your birth month. If you miss your Initial Enrollment Period, you can enroll during the General Enrollment Period (January through March), but you will have to pay a penalty fee. Your monthly premium may go up 10% for each 12-month period you could’ve had Part B, but didn’t sign up. In most cases, you’ll have to pay this penalty for as long as you have Part B.
The only exception to the Part B late penalty fee is if you or your spouse is still working and you have group coverage through your employer or union. Then you can qualify to enroll in Medicare Part B during an 8-month Special Enrollment Period after losing your employer-based coverage.
Medicare Part B generally covers 80% of your medical expenses, meaning you will have to pay the other 20% coinsurance out of pocket. Depending on your situation, these expenses can add up to a lot of money throughout the year. In order to help with these expenses, you can choose to purchase a Medicare Supplement Plan when you enroll in Medicare. These plans will pay the 20% coinsurance that Original Medicare does not pay, as well as other healthcare expenses, like deductibles and copays.
What Is Medicaid?
Medicaid qualifications are dependent on family status, pregnancy, and more.
Medicaid is a health insurance program that is jointly funded by states and the federal government. It is voluntary and is offered based on income, generally to low-income individuals or families. Medicaid qualifications are broadly based on:
Income
Disability
Pregnancy
Age
Household size
Family status
Medicaid covers major medical expenses and is required to cover certain care. Medicaid beneficiaries pay premiums, deductibles, copays and coinsurance.
Medicare and Medicaid may sound the same, but when it comes to coverage and eligibility, they are not the same at all. When you are approaching age 65, it is important to know how to enroll in Medicare, because the longer you push it off, the more you will pay. In order to get properly insured, contact an EZ.Insure agent. We will provide you with expert Medicare help, and even compare Medicare Supplement Plans for free. We want to make the transition from regular health insurance to Medicare as smooth as possible. In order to do this, we will go over your needs and compare all Medicare Supplement Plans to find a plan that will save you hundreds of dollars each year.
To compare quotes within minutes, simply enter your zip code in the bar above, or to speak directly with an agent, call 888-753-7207.
You and your spouse are probably used to doing a lot of things together. While you were working, healthcare was probably one of the things that you participated in jointly. If you had an individual or employer-based insurance plan, you and your spouse were probably on one plan, which helped you to save money. So now that the time has come to enroll in Medicare, you might be wondering whether you can save money by being on the same Medicare plan. Because Medicare works differently from private insurance, the short answer is no. Medicare plans are issued on an individual basis, so you and your spouse cannot be on one plan.
How Medicare Works
You can delay Medicare Part B if you are working, and then enroll later without a penalty.
Some people are automatically enrolled in Medicare Part A, and others have to sign up for it manually. In most cases, this depends on whether you’re already receiving your Social Security benefits. If you are 65 and collecting Social Security, then you will automatically be enrolled into Medicare Part A. If you decide to hold off on collecting Social Security, then you will have to manually enroll in Medicare Part A when you turn 65.
Because Medicare Part B has a monthly premium, it is optional; this means you will have to sign up for it yourself during your Initial Enrollment Period (the 3 months before you turn 65, the month you turn 65, and the 3 months after you turn 65). If you do not enroll in Part B during your Initial Enrollment Period, then you will face a late penalty for every year you push off Part B enrollment. If you are still working at 65, then you can opt out of Medicare Part B enrollment without facing a penalty fee, as long as your employer has 20 or more employees.
Both Medicare Parts A and B are plans for one individual person, offered by the government and paid for by the taxes you contributed while you were working. Even if your spouse is already enrolled in Medicare when you turn 65 and enroll in Medicare yourself, your plans will not be connected. As mentioned above, Medicare does not work in the same way as a private health insurance plan, which would allow you to join your spouse’s plan and receive the same benefits. Everyone enrolled in Medicare Parts A and B receives the same benefits; the differences in coverage comes when you choose to enroll in Medicare Advantage or a Medicare Supplement Plan.
Medicare Supplement Plans
Medicare Supplement Plans will help you save on medical expenses based on your individual needs.
Medicare Parts A and B are individually issued by the government; Medicare Advantage plans and Medicare Supplement Plans are private plans but are also connected to one individual beneficiary. Unlike Original Medicare, though, the coverage they offer differs from plan to plan and person to person. Each Medicare Supplement Plan will have different access to healthcare providers and different networks. What works for one person might not work for another. Because Medicare Part B only covers 80% of costs, many Medicare beneficiaries choose to enroll in a Medicare Supplement Plan to reduce their out-of-pocket costs.
Medicare Supplement Plans are only sold on an individual basis, so you and your spouse will need to purchase separate plans, and may be offered different coverage depending on your needs. If you get a Medicare Supplement Plan through the same company, though, you might be able to take advantage of household discounts. Some companies will offer a discount if one or more members in your household have a plan from the same company.
When Choosing A Plan
Even if you could enroll in your spouse’s Medicare plan, doing so would not provide any extra benefits for you. All Original Medicare plans offer the same benefits, and the beauty of Medicare Supplement Plans is that there are 10 to choose from, so you can get benefits tailored to your needs. But in order to get maximum coverage and to save money, you will have to compare plans and research your options to determine which plan will best fit your financial and medical situation. For example, when looking for a Medicare Supplement Plan, you should talk to your doctors to make sure that they accept Medicare assignment and that they are in each plan’s network.
When you are ready to enroll in Medicare, contact an EZ Medicare agent. We want to make sure you can continue seeing your doctors, getting your medications, and being treated for any conditions. We also want to make sure that you can save money while doing so! We will research all possible options in your area and provide you with quotes so you can make an informed decision for your healthcare needs. All of our services are free, and there is no obligation to sign up. We want to help you get covered! To compare plans in minutes, enter your zip code in the bar above, or to speak to a licensed agent, call 888-753-7207.
Many people wonder if Humana and Medicare are the same. Simply put, no. Medicare is a government administered health insurance program, and Humana is one of the largest private insurance companies. People get these two confused because Humana sells Medicare Advantage and Medicare Supplement Plans. Let’s go over what exactly the two are.
When comparing Medicare and Humana, it can be like comparing apples and oranges. They are two different things.
Medicare
Medicare is the nation’s largest health insurance program for adults 65 and older. It is operated by the Centers for Medicare and Medicaid Services (CMS) under the US Department of Health and Human Services (HHS). Medicare is used by over 57 million Americans, and it is not based on income, and it is not free. In order to be eligible for Medicare, you must meet some requirements:
You must be 65 and older.
You must have worked and paid at least 40 qualifying quarters, or 10 years, of Medicare taxes to receive Medicare Part A.
You must be a U.S. citizen.
Medicare benefits are divided into two parts, Part A and Part B.
Medicare Part A and Part B covers a number of hospital and medical services.
Medicare Part A (Hospital Insurance) — covers inpatient hospital care, skilled nursing facility care, short-term nursing home care, hospice care, and some home health care. (100% of your costs for up to 60 days in a hospital or up to 20 days in a skilled nursing facility.)
Medicare Part B (Medical Insurance) — covers annual wellness visits every month, ambulance services, orthotics and prosthetics, medical equipment, and mental health care. (80% of costs covered by Medicare.)
Medicare will cover 80% of your Part B expenses, leaving you with 20% to pay out of pocket. If the expenses get to be too much to budget, you can look into additional coverage to pay for the 20%, such as Medicare Supplement plans. These plans vary by premium, deductible, and coverage. Additionally, they are helpful to those who travel, as some cover international health care costs.
Humana
Humana is a private insurance company that sells Medicare Advantage plans, and Medicare Supplement plans for people looking for secondary insurance to help pay for Original Medicare.
Humana is contracted with the federal government to provide these Medicare plans under the Medicare program.
If you have Medicare and are interested in a Medicare Supplement plan, EZ.Insure can help! There are roughly 10 different types of medicare supplement plans on the market, and they all vary in coverage and cost. Figuring out which plans are best for you can be hard, but we are here to help. If you would like to gather more information on Medicare and Medicare Supplement plans, one or our highly trained agents are ready to help.
You can start by simply entering your zip code in the bar above to get a quote, or you can contact us by email at [email protected] or call 855-220-1144. There is no hassle and no obligation. We will help you answer any questions, go over all of your plan options, find the Medicare Supplement plan most suited for your needs and budget, and even help you sign up if you’re ready.
If you are turning 65 soon you might be looking for information on your Medicare eligibility, and what exactly having Medicare means. Medicare provides insurance to seniors under plans known as Parts A and B. Part A is hospital insurance, and Part B is medical insurance. While Part A is free, Part B is only covered up to 80% by Medicare, leaving you to pay for the other 20%. Unfortunately, some people are unaware that they must sign up for Part B within a certain timeframe, and can face a Medicare penalty.
In order for Medicare beneficiaries to avoid a penalty, Congress will begin notifying them to sign up before they turn 65.
Currently Medicare does not notify you when it is time to sign up and it is up to you to be aware of the standard enrollment periods. If you do not sign up for Medicare Part B within the specified enrollment period, then you will face a life-long penalty. Luckily, in order to help people avoid this penalty, Congress is considering making revisions to a bill called the BENES Act.
The Medicare Penalty
Medicare Part A normally kicks in when you turn 65 on its own, there is no action required from you. You can enroll in Part B three months before you turn 65, the month you turn 65, and three months after the month you turn 65. While it is mandatory to enroll into Medicare Part A when you turn 65, you do have the option to opt out and put off your enrollment into Part B. Generally this will cause a penalty to be applied to your future Medicare rates unless you qualify for a special enrollment period.
The qualifications for a special enrollment period are:
You have coverage by a group health plan through you or your spouse’s current employment.
During the 8 months following the month your group health plan coverage ends, or when the employment ends (whichever is first).
If you do not qualify for a special enrollment period, then you will only be able to join during The General Enrollment Period, or GEP.
The GEP, which falls between January 1 and March 31 of every year, is the period of time when you can enroll in Medicare Part B for the first time. Coverage will then begin the following July. However, if you skipped the initial enrollment period when you turned 65 and waited for a GEP, you will be at risk of facing a penalty.
If you miss the opportunity to sign up for Part B when you are eligible, you will face a 20% penalty for every year you did not sign up.
When you do decide to finally sign up for Medicare Part B, you will then have to pay an additional 10% on top of your monthly premiums. For every full 12-month period (calendar year) that you were eligible for Part B, but did not enroll in it, you will pay a 10% penalty for as long as you have Part B. For example, if you opt out of signing up for Part B benefits for two years, then you will face a 20% penalty fee added onto your monthly Part B premiums forever.
The Problem
Unfortunately, some seniors mistakenly assume they can skip Part B because they have a former employer’s insurance through the ACA, or for other reasons. This leads to the beneficiaries facing a monthly Part B penalty for the rest of their lives. According to research, in 2018, about 760,000 people were paying a late penalty onto their monthly Part B premium, increasing their costs an average of nearly 30%. Congress thankfully is stepping in to try and end the Medicare penalty by notifying the beneficiaries before they turn 65.
Congress’ Approach
Congress hopes to revise the Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act, so that Medicare & Medicaid Services are required to notify people before their 65th birthday about their Medicare eligibility. Currently, the government only contacts people who are receiving Social Security benefits to notify them when it is time to sign up for Medicare.
The hope is that this would lead to beneficiaries avoiding the Part B penalty when they do not sign up for 12 or more months after they become eligible.
If passed, the revision would be the first one in five decades. This would move the GEP (January through March) window to the fall, which would coincide with the enrollment period for drug coverage and Medicare Advantage. It would also do away with the July effective date, and move it to January.
When dealing with an illness or disability that leads to the assistance of durable medical equipment such as an adjustable bed. Questions come up, mainly how much they are, and if the costs of these beds are covered by Medicare Insurance.
Adjustable beds will be covered under Medicare if they are deemed medically necessary.
Doctors can prescribe these beds for many conditions, such as sleep disorders, respiratory problems, restless leg syndrome, and more. If you do require an adjustable bed, then it must be deemed “medically necessary” by your doctor in order to be covered. Will it be completely covered? Well, it depends.
What Is Durable Medical Equipment (DME)?
Durable medical equipment is medical equipment that is reusable, such as crutches, wheelchairs, and adjustable beds. In order for a DME to be covered, it has to be used for medical reasons, durable, andused at home.
If you are staying in a nursing home, that does not qualify as your home. Therefore, it will not be covered. However, a long term care facility can give you DME, because they are responsible for your health.
Is it Medically Necessary?
Even though your doctor might determine that there is a medical purpose for DME, it does not mean it will be approved by Medicare. Once the doctor recommends it, it must be considered and reviewed by Medicare before it will pay. Not all DME is created equal. In other words, there might be a specific type of bed that is approved, while others are not.
Adjustable beds are usually prescribed to patients to help cure, relieve, and minimize circulatory and respiratory health issues. These beds help people get in and out of bed with more comfort and ease.
Medicare Part B will cover 80% of the adjustable bed expense, leaving you to pay the rest (20%).
Will Medicare Cover Adjustable Beds?
Under Medicare Part B, in the DME section, it states that they might cover adjustable beds. But there are some requirements that a person must meet first before qualifying. First, a doctor must prescribe the bed for use at home. Afterwards, the bed must be sourced by an accredited Medicare supplier. Then, Medicare Part B will cover 80% of the expense, leaving you to pay the rest (20%).
Thankfully, if you are in need of an adjustable bed in your home due to chronic pain, or certain conditions, Medicare will cover it. As long as the bed is prescribed as medically necessary, and acquired from an accredited supplier, then you will be good to go. Make sure you contact Medicare to make sure the bed is accredited before purchasing it, because some bed suppliers will mislead patients into buying unaccredited beds.
Medicare normally kicks in when you turn 65. You can enroll 3 months before you turn 65, the month you turn 65, and three months after the month you turn 65. While it is mandatory to enroll when you turn 65, you do have the option to opt out and push your enrollment into the program. However, when you do this, you are at risk of facing a penalty.
There are some ways to avoid the Medicare penatly, such as if you have employer’s health insurance.
Having Coverage
If you are still employed, or have coverage, then you can opt out of signing up for Medicare. As long as your employer has 20 or more employees, then you can hold off on Medicare, and will not have to worry about the penalty. You can still sign up for Medicare Part A. It does not cost you anything and will cover hospital visits, and can act as a secondary insurance to your employer’s insurance.
Collecting Social Security
If you are collecting Social Security, then you will automatically be enrolled into Medicare Parts A and B. You have the option to cancel or opt out of Part B if you have coverage through an employer. However, if you opt out, then you will face a penalty. Medicare Part B covers doctors’ services, outpatient care, and medical equipment.
The Penalty
Opting out of Medicare Part B without a valid reason, such as being on an employer’s insurance, then you will pay a penalty fee. When you decide to finally sign up for Medicare Part B, then you will have to pay 10% to your monthly premiums. This penalty can remain as part of your monthly premiums for a long time.
Every full 12-month period (year) that you could’ve had Part B, but did not take it, you will pay a 10% penalty for as long as you have Part B. For example, if you opt out of signing up for Part B benefits for 2 years, then you will face a 20% penalty fee added onto your monthly Part B premiums forever. If you opt out for 4 years, then you will face a 40% penalty, as so forth.
The Medicare penalty you will face is 10% for every year you opted out of Medicare.
When You Are Safe From Penalties
If you miss your enrollment date, you have a General Enrollment Period, GEP, in which you can sign up if you missed signing up when you were eligible. It is a make-up time for Medicare enrollment and us January 1-March 31 every year. If fewer than 12 months have elapsed, then you will not pay a penalty fee. Other situations you can avoid the penalties are:
If you have Medicaid and Medicare. The state pays the Part B premiums.
If you qualify for assistance from your state in paying Medicare costs under a Medicare Savings Program.
It is not mandatory to sign up for Medicare when you turn 65, depending on your situation. If you do not sign up when you are supposed to, then you will be penalized, unless you have employer coverage or are in the aforementioned situations. It is best to go over your situation and make sure you are making the best decision. Talk to a Medicare agent beforehand so that you are aware of all of your options, and how you can avoid any extra fees.
EZ.Insure can help you with these kinds of situations. We offer specialized Medicare agents within your area that can go over all of your options and make sure you are in the best situation. If you would like to speak to an agent, call 888-753-7207 or email us at [email protected]. Or if you would like an instant quote, enter your zip code in the bar above. Our services are free, because our goal is to help you, and make sure you are taken care of.
