Image Caption: Medicare written on wooden blocks and a stethoscope.

Comprehensive Guide to Medicare 2022

For more than half a century, senior Americans and persons living with disabilities have used Medicare to cater to their health needs. The program is currently serving nearly 60 million people and will help more than 61 million in 2022 to settle bills tied to hospitalization, visits to the doctor, drugs, and more.

As a rule of thumb, you qualify for Medicare at 65, but you could also qualify automatically. For example, if you’re under 65 but living with a disability, have ALS, or you receive retirement benefits from Social Security (SSI) or the Railroad Retirement Board (RRB).

If you’re turning 65 in 2022, now is the time consider your options.

If you’re turning 65 in 2022, you’ll need to make time before your birthday to go through all of your options and enroll in the Medicare plan that best meets your health needs and budget. This blog will delve into the important aspects of Medicare in 2022 that you need to know.

Things You Should Do Before Enrolling

Your Medicare Initial Enrollment Period, otherwise called IEP, lasts seven months –three months before your 65 years birthday, during your birthday month, and three months after it. You may have to deal with paying a penalty if this period elapses and you’ve still not signed up.

Doing helpful research during the 7-month window can help you get the best out of the program. For example, list down every doctor you have that you need to keep seeing moving forward.  Also, list down your medications to ensure the plan you opt for covers these needs. Further, ensure Medicare supports your lifestyle.  If you go in and out of state frequently and need to see different doctors, this is a vital consideration for your Medicare plan.

You also need a plan you can afford. Medicare comes with out-of-pocket charges in different instances. You should find out what they are and if possible, find out how the government can help you pay for what you can’t afford.

Medicare Components

Medicare has four components:

  1. Part A is about health insurance and covers in-patient care in hospitals, skilled nursing facility care, hospice care, and home health care.
  2. Part B caters to medical insurance and covers services from doctors and other healthcare practitioners, outpatient care, home health care, durable medical equipment such as walking aids and hospital beds, and preventive services such as screenings and vaccines.
  3. Part C is also called Medicare Advantage and contains the components of parts A, B, and D.
  4. Part D takes care of your drug needs by covering the cost of prescription drugs.

Image: Online consultation with a doctor.Medicare Options in 2022

You have two options under Medicare in 2022 –Original Medicare and Medicare Advantage. Here’s a breakdown of both.

Original Medicare

This option includes plans under part A and part B, that is, hospital insurance and medical insurance. Under this plan, you can join a different Medicare plan to benefit from part D. Also, you’re not limited to the doctors you can see, and neither are you limited to the number of states in the US where you can get medical attention –as long as these doctors and hospitals use Medicare.

Under Original Medicare hospital insurance and medical insurance is included and you’re not limited to the doctors you can see.

To ease the burden of out-of-pocket costs, for example, 20% of your coinsurance, you’re allowed to get supplemental coverage – a former employer, union, or Medicaid.

Medical insurance services (Part B) require monthly premiums and you’ll pay another premium should you choose to also have Part D (prescription drugs services). The Original Medicare plan only covers the ‘medically necessary’ services and supplies. Services like check-ups, some dental services, and eye examinations are not deemed ‘medically necessary’. When it comes to getting medical treatment outside the US, Original Medicare does not offer any coverage. You can only get emergency treatment under a Medigap policy that covers those services.

Medicare Advantage (Part C)

Medicare Advantage is an alternative to Original Medicare that is offered by a private company. It offers health insurance, medical insurance, and drugs (Parts A, B, and D). Medicare Advantage may feature lower out-of-pocket costs and provide coverage for services that don’t qualify as ‘medically necessary’ under the Original Medicare –such as eye and hearing treatments and dental services.

Medicare Advantage may feature lower out-of-pocket costs and provide coverage for services such as eye and hearing treatments and dental services.

However, you need to use doctors that are under the Medicare network, and you may need a referral to see a specialist. Additionally, you must pay a part B premium and may have to pay an additional premium for the plan.

Medicare Advantage plans have a 12-month limit on out-of-pocket costs of part A and B services -but you pay nothing for those parts when you reach the limit. Most plans under Medicare Advantage include drugs, therefore, you don’t need to join a different Medicare drug plan- although most plans don’t allow you to do it. Plans under Part C don’t cater to treatment outside the country, but some come with a supplemental benefit that caters to urgent medical attention when you’re out of the country.

How Medicare Works with Other Insurance

In case you have Medicare and other health insurance, here is what you need to know about how all of them work together:

  • When there are multiple players, each coverage you have is called a payer.
  • The responsibilities of each are governed by the coordination of benefits rules.
  • The insurance that pays first, also called the primary payer, pays as much as it is legally allowed.
  • The one that pays after the primary payer, also called the secondary payer, only pays the costs that the primary payer didn’t.
  • The secondary payer does not always fully cover the unpaid costs.
  • Medicare is the primary payer where you have retiree health coverage, have Medicaid, or are under 65 and living with a disability.
  • Medicare is also the primary payer if you’re under 65 and living with a disability, have group plan coverage under a family member’s current job, and the employer has fewer than 100 employees.

How to Enjoy Your Retirement

While Medicare is not a legal requirement, good health and the right care have everything to do with how well you live out your retirement. If you or a senior loved one needs assisted living, compassionate and expert healthcare in a serene environment, our facility offers Skilled Nursing and other services that are covered under Medicare. For more information go to our contact us page and call us or send an email.

For more information on Medicare in 2022, visit the Medicare Resource Centre.