The type of Medicare plan you choose determines whether you may have coverage in all 50 states or within a specific care network.
Medicare is a federal health insurance program available to older adults ages 65 and older, and those with certain disabilities. Medicare enrollment begins with your Initial Enrollment Period (IEP), which lasts for seven months and opens three months before your 65 birthday (or four months before if you were born on the first of the month). Whether you receive Social Security payments or use an employer insurance plan can impact enrollment. Here’s how it works:
Original Medicare covers hospital insurance (Part A) and medical insurance (Part B). Original Medicare covers most of your needs, but not all. If you want prescription drug coverage, you can join a separate Medicare prescription drug plan (Part D). Also, you can choose to enroll in supplemental insurance to help pay out-of-pocket costs, like copays and coinsurance. Through programs like Medicaid, some may qualify for extra financial help based on limited income.
A different Medicare option to get Part A and Part B is Medicare Advantage (Medicare Part C). Sometimes referred to as “bundled” plans, Medicare Advantage plans usually include Part D with Part A and Part B. Most of these plans will include more benefits than Original Medicare, like vision, dental, and hearing. Unlike Original Medicare, these plans require you to use providers in the plan’s network. Still, these plans may have lower out-of-pocket costs than Original Medicare.
Because Medicare is a federal insurance program, the core elements of Medicare are the same in each state, but there are a few exceptions when it comes to certain parts.
Original Medicare allows you to see any provider that accepts Original Medicare in all 50 states. Medicare Advantage may limit you to providers in the plan’s network service area, but the plan is required to cover emergency care and urgent care in all 50 states.
If you select to add Medicare Supplement insurance, the plan is standardized in nearly all 50 states with the exception of Massachusetts, Minnesota, and Wisconsin. Each state has the option to offer additional benefits beyond the federally determined “standard.”
Some people are eligible for both Medicare and Medicaid. To qualify for Medicaid, you must apply with your state Medicaid office. Not all states have the same requirements to qualify for Medicaid.
Some states may have 5-star rated Medicare plans available, but the rating doesn’t always mean it’s the right plan for your needs. It’s important to do your homework, and a licensed insurance agent can help you compare options and find a plan that meets your needs.
Medicare Advantage plans can be evaluated and scored by providers and patients to determine how well specific plans meet the needs of beneficiaries. In most cases, Part A and Part B coverage is rated in five different areas and Part D is rated in four different areas. Total ratings are averaged to create a collective “star rating.” Before you decide you want a five-star rated plan, make sure you know what you need and if that plan covers it. If you choose a five-star plan, but it doesn’t cover your monthly prescription needs, you may find yourself in an expensive situation when another plan (not five-start) may have been a better option.
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