作者:Rhea Maze

对医疗保险感到困惑? 你并不孤单. The federal system of health insurance for those 65 years of age and older (and some younger people with disabilities) is hardly simple and straightforward.

Let’s clear up three big misconceptions right away. First, Medicare is not free health insurance coverage. While some assistance is available based on a person’s income, 大多数人将不得不支付免赔额, 元钱, and even monthly premiums depending on what plan(s) they choose. Second, not all types of care are covered, including basics like dental, 愿景, or hearing. Third, Medicare generally does not cover long-term care except in certain circumstances.

在COVID-19大流行期间, most Medicare recipients DO have coverage for doctor-ordered testing, 住院与病毒有关, 远程医疗, 如果能研制出疫苗. (If you have Parts A and B, read on for descriptions.)

Alan Heileman has heard all of the myths and understands the confusion. “People are intimidated by Medicare and see it as a vast jigsaw puzzle with too many pieces,海尔曼说。, coordinator of community programs with UCHealth’s Aspen Club. “And while it is true that there are many options, Medicare really comes down to a few basic parts.”

我们请他解释一下老年医保是如何运作的:

AH: The basic parts of Medicare are hospital insurance, 医疗保险, 处方药保险, 还有保险来填补空缺. The first thing someone approaching 65 will need to decide is whether to go on Original Medicare or Medicare Advantage. 你不会自动加入联邦医疗保险 除非 you have been receiving Social Security for at least four months or getting benefits from the Railroad Retirement Board for four months or longer by your 65th birthday. Your first chance to enroll is 在 the Initial Enrollment Period which is the three months before you turn 65, 你65岁的那个月, 还有你生日后的三个月. (请继续阅读其他注册选项.)

What are some differences between Original Medicare and a Medicare Advantage Plan?

AH: Medicare does not cover hearing exams or hearing aids, 愿景, 或者牙齿护理, 但一些医疗保险优惠计划可以. 如果是原始医疗保险, you will most likely need to purchase a drug plan and can also supplement your coverage with a 补充性医疗保险 plan to pay for some of the deductibles and 元钱 that aren’t covered. Those on Medicare Advantage will most likely have a drug plan included, 是否需要使用网络内提供商, 不能有额外的医疗保险计划.

What’s the deal with all those letters (A, B, C, 和D)?

AH: That is the basis of Medicare and where it all starts.

部分 is hospital insurance provided by the 政府ernment. Most Americans do not pay for this and it covers hospital stays and rehab, 有免赔额和共付额.

B部分 医疗保险由政府提供吗. It covers doctors, physical therapy, medical equipment, etc.，以及门诊心理健康服务. This includes coverage for COVID-related testing and treatment. 它有免赔额、共付额和保险费. 如果你超过了一定的限度, you’ll pay an income-related monthly adjustment in addition to your plan premium.

D部分 is a prescription drug plan sold by private insurers. 保费可能每年变动 and are based on your income. 如果你超过了一定的限度, you’ll pay an income-related monthly adjustment in addition to your plan premium.

Be sure you learn about Medicare before you first become eligible when turning 65—there may be significant penalties if you don’t sign up by the deadlines that apply to you. If you are still working and getting employer coverage at age 65, your deadlines will depend on your specific situation.

C部分 医疗保险优势是由私人保险公司出售的吗. 你必须先有A部分和B部分. Most Medicare Advantage plans are a combination of parts A, B, 和D, and typically provide other types of benefits like dental, 愿景, 和听力. Deductibles, 元钱, monthly premiums, and out-of-pocket maximums vary by plan and even by state. 保费可能每年变动.

最后, 补充性医疗保险, 或医疗保险补充计划, 是按相同字母排列的吗, 这可能会让人困惑, but they are not related to the main parts of Medicare. These private health insurance plans help you cover certain out-of-pocket Medicare costs such as deductibles, 共同支付, 和共同保险.

Once you’ve considered your options, there are several chances to enroll. If you don't sign up for 部分 and/or B部分 在 the Initial Enrollment Period (the 7-month period before, 在, 在你65岁之后), you can sign up 在 the General Enrollment Period between Jan. 1 and March 31 each year, for coverage beginning July 1.

想转投医疗保险优惠计划, return to Original Medicare or add/change a prescription drug plan? 医疗保险的年度选举期为10月6日. 12月15 - 12月. 7 is the time to enroll, dis-enroll, or choose a new plan that will then take effect on Jan. 1.

还有其他内幕消息吗??

AH: Several programs offer assistance for those living on lower incomes who qualify. And be sure to check your drug plan every year 在 the Annual Election Period! 即使你的处方没有改变, coverage formulas do change and odds are you will save money shopping for the best plan.