Medicare Guide Download

Medicare is a type of medical insurance that you can obtain if you meet the age requirements or if you have a qualifying health condition or disability. This type of insurance is divided into several different parts that can cover a wide range of medical needs. You may have to sign up for multiple parts of the program in order to get all of the coverage that you need.

Learning about your Medicare eligibility is an important step before you apply. In some cases, you will automatically receive coverage if you meet the requirements. Other times, you will have to sign up for Medicare on your own. After your coverage starts, you must familiarize yourself with finding providers and learn how your insurance works outside of the U.S. As your situation changes, you can always add or drop certain types of coverage in order to have all of your needs met throughout your life.

Medicare Basics

Medicare benefits are reserved for people who are at or near retirement age or who have a disability or certain medical conditions. Medicare insurance works much like a private insurance plan, in that it helps beneficiaries pay for certain medical services and treatments. People who have this type of insurance must choose doctors that accept their coverage, and they can only receive services that are included with their policy.

Medicare health insurance can also be used in conjunction with other types of insurance if a beneficiary is eligible for multiple coverages. If this is the case, each type of insurance will typically pay for its share of the costs and the insured will need to cover the remaining expenses, if necessary.  

Get an more in-depth explanation of Medicare by downloading our helpful Medicare guide.

Medicare Eligibility

Your eligibility for Medicare is determined either by your age, disability status or the presence of certain health conditions. If you are not receiving disability benefits or do not have an eligible health condition, you will not meet the Medicare qualifications until you reach 65 years of age or start getting retirement benefits.

It is a common misconception that your income level affects your eligibility for coverage. In reality, income only determines the premiums that you pay for certain types of coverage. It does not affect whether you are able to receive insurance in the first place.

How to Apply for Medicare

Medicare enrollment can seem like an overwhelming experience at first. Some people will be signed up for coverage automatically, while others must apply on their own. You must enroll in Medicare yourself if you do not receive automatic coverage. With that in mind, it is crucial that you are aware of your eligibility for this type of insurance. You only have a few months in which you are allowed to submit your initial application. If you wait too long, you risk having a gap in coverage and having to pay a penalty on your premiums.

If you are unsure of how to sign up for Medicare, there are many resources available to help you through the process. Applications are accepted in a variety of ways, including online, in person or over the phone.

Note: If you need to make changes to your Medicare coverage, you can only do so during the appropriate open enrollment or general enrollment period. You can also sign up for coverage during these periods if you missed your initial enrollment deadline.

Costs and Coverage

Learning about the Medicare cost is important whether you are signing up for your first plan or you are considering getting a different type of coverage. Medicare costs a different amount depending on the types of coverage you have as well as your income. However, certain types of coverage are also provided for free as long as you meet the correct eligibility requirements.

Medicare Plans

When choosing coverage, you will want to learn about the different types of insurance available. Plan options include the following:

  • Medicare Part A (hospital insurance) covers inpatient hospital stays and certain types of care provided in nursing homes and hospice settings.
  • Medicare Part B (medical insurance) covers outpatient services, medical supplies and preventative care.
  • Medicare Part C, also known as Medicare Advantage, typically covers the same services as Parts A, B and D, but is offered by private insurance companies.
  • Medicare Part D helps you pay for prescription drugs.  

You can learn more about the different parts of Medicare and the coverage they provide by downloading our Medicare guide.

Finding Medicare Providers

The type of health care providers you can use will depend on what type of coverage you have. For example, a Medicare Advantage plan will be accepted by hospitals and doctors who are in your private insurance plan’s network. On the other hand, you must choose specific doctors and hospitals that accept Medicare if you have Part A and B coverage. If you have a specific medical need or want to see a particular doctor, you can also search to see if your insurance will cover it.

Denials, Appeals and Claims

Once you have coverage, it is helpful to understand the process of making appeals, complaints and claims. Medicare appeals can be filed when you believe that a certain medical need or prescription drug should be covered by your insurance. A complaint, on the other hand, is something that you can submit if you feel dissatisfied with the level of service or care that you receive while using your insurance.

Finally, Medicare claims are filed after you receive services or supplies that are covered by your insurance. A health care provider will almost always file a claim on your behalf, but in some situations, you may need to submit one on your own.

Medicare and Private Insurance

Medicare insurance coverage can work in conjunction with other forms of insurance, including private plans and other government-run programs such as Medicaid or VA insurance. When you have a secondary form of insurance, such as a private plan, each policy will pay its share of your health care costs. Depending on the circumstances, one of your plans will always pay first, while the other will pay second for any remaining costs.

Medicare While Traveling Abroad

In rare cases, you can use Medicare overseas, but it is important to understand that most services will not be covered with a traditional plan while traveling outside of the U.S. Whether you are visiting another country or are living abroad, you will need to carefully consider your coverage choices. Medigap plans, which are a form of supplemental insurance, may be a solution. These plans oftentimes provide coverage that you cannot receive from a traditional plan.  

Medicare and Long-Term Care

If you plan on moving to a senior living center or anticipate that you will need nursing home or hospice care, you will want to consider the expenses you may face. With Medicare assisted living, costs are not always covered. Your insurance will only pay for short stays in a nursing home, or for specific types of care that are provided in hospice or nursing home settings. For example, your insurance will not cover basic daily needs such as getting dressed or bathing, which do not require skilled nursing care. Always plan ahead by checking which expenses you will be expected to cover out-of-pocket.

For more information on long-term care and other Medicare services, download our comprehensive guide.