Learning about Medicare can be very overwhelming for a lot of people. There are plans to understand, prices to compare, benefits to find, and more. If you’re someone just starting to learn about Medicare or who’s looking for more information, you’re in the right place. Here are six facts about Medicare you should know.
- Medicare Beneficiaries can use Original Medicare in any state.
Some people become confused about Original Medicare’s network. Original Medicare refers to Part A and Part B, which provide inpatient and outpatient coverage. Well, Original Medicare doesn’t have a network and is valid throughout all the states. Although it’s true some doctors won’t accept Medicare, most of them will.
The piece of information that slips people up sometimes is the difference between Original Medicare and Medicare Advantage (MA) plans. While Original Medicare provides benefits through the federal government, MA plans offer benefits through private insurance companies. These MA plans operate within specific network areas in a local or regional area.
- You can be penalized for missing specific enrollment periods.
Many people don’t know there are enrollment periods to be aware of when signing up for the different parts of Medicare. These enrollment periods are important, and you should research them carefully or run the risk of receiving a penalty.
One example of this is the Initial Enrollment Period (IEP). This is a 7-month window for you to enroll in Medicare Part A and Part B for the first time when you turn 65. If you miss your IEP, you’ll most likely be required to pay a 10% penalty for every 12-months you go without Part B. There are a few exceptions, but for most people, this penalty is for life.
The bottom line here is to be aware of all the different enrollment periods so you won’t be penalized at all.
- There is no annual election period for Medigap plans.
To change your Medigap plan, you will most likely have to answer health questions and pass underwriting when you enroll in a plan outside your Medigap Open Enrollment. One of the most common misconceptions is that the Annual Election Period (AEP) is a chance for you to change your Medigap plan without underwriting, which isn’t true.
The AEP takes place from October 15th to December 7th and was created to change your MA plan or Part D plan, not a Medigap plan.
Only certain states, such as Connecticut and California, allow you to enroll in a Medigap plan without underwriting at a specific time of the year. But, there is not a nationwide election period specifically for changing Medigap plans. You can change Medigap plans anytime during the year with possible restrictions and passing underwriting in most cases.
- You must pay the Part B premium even if you’re enrolled in a Medicare Advantage plan.
Another common misconception is that you don’t have to pay the Part B premium if enrolled in a MA plan. You must pay the Part B premium if you’re enrolled in a Medigap plan or a MA plan. It doesn’t make a difference.
The Part B premium for 2021 is $148.50. This amount is subject to change every year, so be sure to look out for that. However, MA plans usually have lower premiums compared to Medigap plans, which can be a plus for some people.
- The Medicare Part D Donut Hole has not ended.
Medicare Part D provides coverage for prescription medications. If you and your insurance spend a certain amount on your medications at the pharmacy, you enter the Donut Hole. The Donut Hole is a gap in the Part D coverage where the price of your medications can increase. Some people think the Donut Hole has ended, but that’s not correct.
The 2010 Affordable Care Act has helped this coverage gap decrease as time goes by but not disappear. Currently, in 2021, you would have to pay no more than 25% for prescriptions medications if you’re in the Donut Hole. Before the Affordable Care Act, you would’ve had to pay 100% for your medications.
- Medicare covers COVID-19 vaccines at 100%.
You won’t need to worry about getting your COVID-19 vaccine covered because Medicare Part B will do it for you. The FDA has approved emergency use for the Pfizer and Moderna Covid-19 vaccine, and as long as you receive one of those, you should have nothing to worry about having out-of-pocket costs. Whether you’re enrolled in Original Medicare or a Medicare Advantage, you will be covered.
Final Thoughts
The Medicare maze can be challenging to navigate. With these six facts, you can start or continue to educate yourself on all things Medicare. The more you know and understand, the better you can make the right plan decisions for yourself!
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