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Medicare Questions & Answers

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Medicare Questions and Answers

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What is Medicare?

Medicare is the federal health insurance program for people who are 65 or older, or those under 65 who may qualify because of a disability or another special situation.

What does Medicare Cover?

Medicare helps millions of American senior and disabled individuals cover some of their health care costs.

Medicare also offers important choices in how you receive benefits – whether through the federal government and Original Medicare (Parts A & B) or through a Medicare-approved private insurer that offers additional benefits like prescription drug coverage (Medicare Advantage plans (Part C) and Medicare Part D drug coverage plans).

The different parts of Medicare help cover the costs of specific services. Medicare has four basic types of coverage: Part A, Part B, Part C, and Part D.

What is Medicare Part A?

Medicare Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

What is Medicare Part B?

Medicare Part B covers certain doctors' services, outpatient care, medical supplies, durable medical equipment, and preventive services.

What Is Medicare Advantage (Medicare Part C)?

A Medicare Advantage plan (Part C) is a type of Medicare health plan (like an HMO or PPO) offered by a private insurance company approved by Medicare to provide Original Medicare (Parts A and B) benefits. Most Medicare Advantage plans can combine hospital, doctor, and drug coverage in one plan, and may include extra benefits not offered by Original Medicare.

What Is Medicare Part D?

Medicare Part D plans add prescription drug coverage to Original Medicare and Medicare supplement insurance plans. These plans are offered by insurance companies approved by Medicare.

Who can get Medicare?

U.S. citizens can get Medicare if they meet one of the following requirements: You must be 65 or older, OR, you must have a qualifying disability if you are younger than 65, OR you can be any age with a diagnosis of end stage renal disease.

Legal residents who have lived in the U.S. for at least 5 years in a row, including the 5 years just before applying for Medicare can get Medicare. A legal resident must also meet one of the following: be 65 or older, OR be younger than 65 with a qualifying disability, OR be any age with a diagnosis of end stage renal disease.

When can I enroll in Medicare?

There are only certain times when you can enroll in Medicare. Depending on your situation, you may get Medicare automatically, and other times, you may need to apply for Medicare.

1) The first time you can enroll is called your Initial Enrollment Period. This 7-month Enrollment Period usually:

-Begins 3 months before the month you turn 65

-Includes the month you turn 65

-Ends 3 months after the month you turn 65

 

2) There are also Special Enrollment Periods (SEPs) when you can make changes to your Medicare Advantage and Medicare prescription drug coverage.  This can happen only when certain events happen in your life, like if you move or if you lose other insurance coverage.

Can Medicare start before I am 65?

The majority of participants qualify for Medicare when they’re 65. However, some people can claim Medicare even if they haven’t turned 65 yet. There are specific conditions that can help you qualify for Medicare early. These conditions may include:

-End-stage renal disease

-Severe illness, injury or disability that keeps you from earning above certain income thresholds if you meet the standards for Social Security disability benefits.

How do I enroll in Medicare?

You can enroll in Medicare Part A and/or Medicare Part B in the following ways:

Can Medicare cards be laminated?

Though it is not illegal, laminating your Medicare card may not be a good idea because there may be some security features within the card that could be compromised by laminating it. Additionally, a health care provider may experience problems scanning a laminated card.

Can Medicare be used out of state?

Yes, Medicare can be used anywhere. If you plan on going out of state, call your provider and let them know what state you are going to. They will give you names of providers that are in the network in case you need one.

Does Medicare pay for in home caregivers?

Medicare has limited coverage for home care, and when it does cover home care, it does so through a Medicare-certified home health care agency.

Will Medicare pay for a wheelchair?

Medicare Part B may cover durable medical equipment, which includes wheelchairs and walkers, if prescribed by a doctor. 

Where can I get more information about Medicare?

For more information about Medicare in Wisconsin, visit the Wisconsin Department of Health Services.

Or you can visit the official U.S. Government Site for Medicare.

What is the difference between Medicaid and Medicare?

Medicaid is a federal program administered separately by each state and that provides health coverage if you have a very low income.  The eligibility rules for Medicaid are different for each state.  You can be eligible or Medicaid regardless of your age. They will work together to provide you with health coverage and lower your costs.  For more information, visit www.Medicaid.gov.

Medicare is a federal program that provides health coverage if you are 65+ or under 65 and have a disability, no matter your income.  For more information, visit www.Medicare.gov.

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