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Medicare can seem really complex and intimidating. If you have questions, you’ve come to the right place! Find your question below, then click or tap on it to reveal the answer. If you can’t find the answer you’re looking for here, speak to a licensed Aetna agent today!
What is Medicare?
Medicare is a federally funded health care program administered by The Centers for Medicare and Medicaid Services (CMS), a division of the U.S. Department of Health and Human Services (HHS).
Medicare began in 1965, the same year as Medicaid, when President Lyndon B. Johnson signed a bill launching both programs. The goal of Medicare was and continues to be providing health care services to those who might otherwise have a hard time accessing them, specifically the elderly, younger people with certain disabilities, and those who suffer from end-stage renal kidney failure.
What are the different “parts” of Medicare?
When it began, Medicare had two parts: Medicare Part A (sometimes called “hospital insurance”) and Medicare Part B (also known as “medical insurance”). Both parts are still available today, and together they are sometimes called “Original” or “Traditional” Medicare. Original Medicare is offered through and administered by the federal government.
Over the years, the government has introduced additional parts to Medicare, available through licensed private insurance companies, to help enrollees gain access to more benefits.
These parts include:
- Medicare Advantage (Part C)
- Medicare Part D (prescription drugs and medications)
- Medicare Supplement (Medigap)
For a list of the services covered under each part of Medicare, please see the question, “What does Medicare cover?” below.
What is a Medicare “beneficiary”?
The term “beneficiary” refers to anyone enrolled in a Medicare plan.
What does Medicare cover?
Each part of Medicare covers a different set of services or health care expenses. Here is a brief overview of what each part covers.
Medicare Part A
Otherwise known as “hospital insurance,” Medicare Part A covers a variety of emergency and long-term care services. These services generally include:
- Nursing homes
- Hospital procedures and stays
- Hospice care
- Home health care that occurs after an inpatient stay
- Blood transfusions that you may receive at a hospital (above three pints annually)
Medicare Part B
Medicare Part B, sometimes called “medical insurance,” pays for a broad range of preventative and other medical services. These may include services such as:
- Doctor visits
- Screenings and lab tests
- Counseling, therapy, and mental health
- Shots and immunizations
- Outpatient care
- Clinical research studies
- Limited outpatient prescription drugs
Note: While many preventative services will be 100 percent covered, others may be billed on an 80/20 coinsurance basis (i.e., after you meet your deductible, Medicare pays for 80 percent of your care, and you pay for 20 percent).
Medicare Part C (Medicare Advantage)
Medicare Advantage plans, also known as “Medicare Part C,” offer all the same benefits as Medicare Parts A and B (“Original” Medicare) above, but with additional insurance for services not covered under Original Medicare.
Depending on your coverage area, your Medicare Advantage plan may include one or more of the following:
- Hearing aids
- Health and wellness programs
- Gym memberships
Note: Some Medicare Advantage plans may also include prescription drug (Medicare Part D) benefits.
Medicare Part D
Medicare Part D covers a wide variety of prescription drugs and medications. Each Medicare Part D plan offers a different range of medications (known as a “list” or “formulary”) at different rates (known as “tiers”), depending on your coverage area, the cost of medications, and whether the drugs you need are generic or brand name.
Medicare Supplement (Medigap)
Medicare Supplement plans (also called “Medigap” plans) help pay for some health care costs not covered by your Original Medicare or Medicare Advantage plan.
These may include expenses such as:
- Care that you receive overseas
Note: Contrary to what the name might suggest, Medicare Supplement plans (or “Supplemental” Medicare plans) do not cover prescription drugs or medications. Prescription drugs are covered by Medicare Part D mentioned above.
What’s the difference between Medicare and Medicaid?
Medicare is a federal program that provides health care benefits for people 65 years and older, as well as for some people who suffer from severe disabilities or end-stage renal kidney failure. Medicare is available to all eligible applicants, regardless of income.
Medicaid, on the other hand, is a state- and federally-run program designed to help lower-income families and individuals gain access to health care services.
In some cases, you may qualify for both Medicare and Medicaid. This is known as “dual eligibility.”
What’s the difference between Medicare and traditional, private health insurance?
Medicare is a federally administered program designed to help people who might not otherwise qualify for a private health insurance policy, so they can get access to the health care they need. Specifically, Medicare provides health insurance benefits for people ages 65 and older and for people with certain disabilities.
These benefits are provided to all eligible applicants, no matter their income level and may provide some benefits at little to no cost to enrollees.
Private health insurance, on the other hand, is commercially run. This generally means that you have a greater range of options regarding coverage and price when purchasing a policy. However, it also means that before you can sign up for a policy, an insurance company will perform a risk assessment based on a number of factors, such as your age and your medical history. Depending on your risk assessment, a private health insurance company may charge you a higher rate for care or deny you coverage altogether.
Note: Depending on which plan you enroll in, Medicare may be offered through the federal government or through a private (but still federally regulated) insurance company.
When am I eligible for Medicare?
You may be eligible for Medicare benefits if one or more of the following apply to you:
- You are 65 years old or older
- You are younger than 65 but suffer from a Medicare-approved disability
When can I enroll in Medicare?
There are three primary enrollment periods for Medicare plans.
Initial Enrollment Period (IEP)
Your Initial Enrollment Period (IEP) begins three months before the month you turn 65 and ends three months after the month of your 65th birthday. So, for example, if you were born April 15, your IEP starts January 1 and ends July 31.
However, if you were born on the first day of a given month, the entire month before your birthday counts as your birth month. In other words, if you were born on May 1, your IEP would likewise start January 1 and end July 31.
Note: If you are younger than 65, your Initial Enrollment Period may be triggered by a disability or other conditions.
General Enrollment Period (GEP)
If you don’t enroll during your Initial Enrollment Period, you can enroll during what’s called the General Enrollment Period (or “GEP”). The GEP begins every year on January 1 and goes until March 31. However, be warned: Enrolling during the GEP may mean you have to pay a late enrollment fee to receive benefits.
Annual Election Period (AEP)
Once you’ve enrolled in a Medicare plan (either during your Initial Enrollment Period or during the General Enrollment Period), you have the option of making changes to your plan during the Annual Election Period, or “AEP.” The Annual Election Period, sometimes called “Open Enrollment Period” or simply “Open Enrollment,” runs each year from October 15 through December 7.
During AEP, you can make any of the following changes to your existing Medicare plan elections:
- Replace your Original Medicare plan with a Medicare Advantage plan
- Add prescription drug coverage to your Original Medicare or Medicare Advantage plan (if your plan doesn’t already have Part D coverage)
- Switch from a Medicare Advantage plan to an Original Medicare plan
- Enroll in a Medicare Supplement (Medigap) plan
- Cancel any of your existing plans
Note: Certain life circumstances may qualify you to enroll in a Medicare plan at a time other than those listed above. This is known as the Special Enrollment Period (or “SEP”). This may include situations such as moving to a new area, living in a nursing home, or qualifying for both Medicare and Medicaid.
What is the Medicare “donut hole?”
Many Medicare Part D plans offer a coverage gap commonly referred to as the Medicare “donut hole.” In a nutshell, this means that once you and your plan have reached a specified amount for covered medications you must pay any additional costs for prescription drugs out of pocket until you meet your annual limit.
The amount of your annual limit will vary depending on your plan and may change from year to year. However, once your annual limit is met, your coverage gap ends and your plan will once again help pay for any additional drug costs. Your coverage gap and annual limit “reset” at the beginning of each calendar year.
Are Medicare payments tax deductible?
The short answer? Yes. On your federal taxes, you can deduct money that you spend on Medicare premiums as long as you meet certain criteria set by the Internal Revenue Service (IRS).
The amount you can deduct from your taxes will depend on a number of factors, including your adjusted gross income (AGI) and other medical expenses you may have had in a given tax year. And keep in mind, too, that the IRS may change its policies in a certain tax year regarding deductions.
For more information about which medical or dental expenses you can deduct from your federal taxes, visit the Internal Revenue Service’s website.
Can I be dropped from Medicare?
If you are enrolled in an Original Medicare or a Medicare Advantage plan (with or without prescription medication coverage), you may lose your benefits if you fail to pay your premiums or move outside your coverage area.
With Original Medicare (Parts A and B), you’ll typically receive two warnings in the mail urging you to make a payment by a specific date.
Since Medicare Advantage (Part C) plans are offered through Medicare-approved private insurance companies, you may be dropped from your plan with or without notice if you don’t pay your premiums.
Note: If you're having difficulty making payments on your Aetna Medicare Advantage plan, please call 1-855-446-0414.
What is the Medicare Modernization Act?
The Medicare Prescription Drug, Improvement, and Modernization Act (or simply “Medicare Modernization Act” or MMA), was signed by President George W. Bush on December 8, 2003. The MMA represents the biggest overhaul to Medicare since the program’s initial launch in 1965.
Among other things, the MMA introduced Medicare Part D, providing optional prescription drug and medication coverage that could be added to an existing Original Medicare or Medicare Advantage plan.
Note: For more information about changes made in the Medicare Modernization Act, visit Congress’s website.
How do I enroll in a Medicare plan?
The simplest and easiest way to enroll in a Medicare plan is to speak with a licensed agent. Your agent can answer any questions you may have and help you find the right plan for you and your loved ones.
Still have questions? No problem!
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