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What is Medicare and How Does it Work?

Medicare is a federal program that older Americans and people with disabilities use for healthcare coverage. According to AARP, in 2020, nearly 61 million individuals were enrolled in Medicare to help pay for healthcare coverage including hospital stays and prescription medicine. Those who receive social security are automatically enrolled in Medicare. However, those who do not must enroll in the program within three months before and three months after they turn 65. Whether you’re enrolling for the first time or want to make changes to your plan, you must do so between October 15-December 7 for the plan to take place on January 1.

It’s no secret that Medicare is a complex program, with many different parts.  Here’s what you need to know to get started.

Understanding Medicare Options

Medicare is a comprehensive program that provides coverage for all health care needs. In general, Medicare offers lower, out-of-pocket costs when compared to traditional commercial health plans. To make the program easier to navigate, it is broken down into four major Medicare parts.

Medicare Part A

Covers inpatient hospital care including hospice care and short-term skilled nursing care. You are automatically enrolled in Part A when you apply for Medicare. In addition to hospitalization, Part A will cover doctor services and lab tests that were done while you are in a hospital or other health care facility. While you do not have to pay a premium, Part A does require a yearly deductible and coinsurance costs.

Medicare Part B

Covers doctor visits, lab tests, diagnostic screening, medical equipment, and ambulance transportation. Part B can involve more out-of-pocket expenses, so if you have insurance through your job or a spouse, you might consider deferring. However, if you don’t have other coverage and choose not to enroll in Part B, you will likely pay a higher monthly premium for the duration of your enrollment. Also, Part B requires an annual deductible and 20% of doctor visits and outpatient services.

Medicare Part C

Is the Medicare Advantage program, which offers an alternative to traditional Medicare (Parts A and B). Medicare Advantage programs are Medicare plans that are offered by Medicare-approved private insurance companies. These plans include Parts A, B, and usually Part D in addition to other benefits such as vision, hearing, and dental programs. While deductibles and copays are usually lower when compared to traditional Medicare, the premiums are higher. Some people choose Medicare Advantage programs for more coverage and to make paperwork and communication easier and more efficient.

Medicare Part D

Covers prescription drugs and is purchased through a private insurer. Many options depend on your needs and prices can vary. It’s best to check to see whether the plans you’re considering cover the medications you need.

Changes to Medicare in 2021

As open enrollment is approaching, it’s important to be aware of the changes being made to Medicare. According to the official U.S. government Medicare handbook, here’s what you need to know before open enrollment:

Coronavirus disease 2019

Medicare has made changes to account for the impact COVID-19 has had on both health care providers and consumers. Medicare will cover lab tests for COVID-19 with no out-of-pocket expenses. In addition, antibody tests will be covered if you have been diagnosed with a known current or known prior COVID-19 infection or suspected infection.

Medicare also covers all medically necessary hospitalizations related to COVID-19. This includes hospital stays to cover quarantine after an inpatient stay. Hospital deductibles, copays, and coinsurances will still apply.

Lower out of pocket costs for insulin

Part D Senior Savings Model will give supplemental benefits for insulin. Plans that participate in this model will offer coverage choices that include multiple types of insulin at a maximum co-payment of $35 for a 30-day supply.

Acupuncture for back pain

Medicare will cover up to 12 acupuncture visits in 90 days for chronic low back pain that lasts 12 weeks or longer and has no known cause. Medicare will cover an additional eight sessions if the acupuncture proves to be improving your condition. It’s important to understand that acupuncture will only be covered for lower back pain and not any other condition.

Telehealth and other virtual services

As telehealth begins to be a popular option for many people, Medicare has announced its coverage will be expanded. Telehealth benefits will allow you to get medical or health services from a doctor who is located elsewhere using interactive audio and video technology. Medicare will also cover virtual services like E-visits and Virtual check-ins.

Tips for Enrolling or Making Changes to Your Medicare Plan

Choose your doctors carefully. If you’re new to Medicare or are looking for a new doctor, it’s important to understand their Medicare status. Providers can have various statuses including participating, non-participating, opt-out, and Medicare Advantage. Depending on their status, the cost of your fee might increase. If you’re preparing to visit a doctor for the first time, it’s not uncommon to set up an interview beforehand. This will allow you to see if they are a good fit or if you need to keep looking.
Avoid surprise charges. Because Medicare is a complicated program, it can be difficult to keep track of which services are covered and which are not. You can always check the Medicare website to make sure you will be covered before having a treatment or appointment. If you receive a surprise bill, don’t pay it right away. Instead, call your provider and Medigap insurer to ask about the bill.
Take advantage of the benefits.   There are so many benefits provided by Medicare that people often forget to use them! Medicare covers annual wellness visits, eyeglasses, telehealth visits, nutrition counseling, and counseling for smokers who want to quit.

• Keep good records. Experts suggest keeping records of your medical history including hospital stays, any conditions you have, your prescription drug list, medical equipment you use, pharmacy information, and emergency contact information. This will help you if you ever need to switch doctors or if you have an issue with your Medicare plan and need to access information quickly.

Learn More about Medicare at Maplewood Senior Living

At Maplewood Senior Living, health is our number one priority. We know Medicare can be confusing, but enrolling in the program and keeping up-to-date with changes will allow you to access the best health care possible. For more information, or to schedule a tour, please contact us here.

We are offering a Complimentary Course on Medicare that we are hosting on October 15th at 4pm. To RSVP and get your Zoom login information, please email:

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Westport, CT 06880

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