Question 1

When should I sign up for Medicare?

Accepted Answer

Sign up during your Initial Enrollment Period: three months before you turn 65 through three months after. Some get signed up automatically; others must enroll manually to avoid gaps or penalties.

Question 2

What are the parts of Medicare and what do they cover?

Accepted Answer

Part A covers hospital stays, skilled nursing, some home health, and hospice care. Part B covers doctor visits, outpatient care, medical supplies, and durable equipment. Part C (Medicare Advantage) offers private plans combining A & B, often with extra benefits. Part D provides prescription drug coverage through private plans.

Question 3

What happens if I miss my initial Medicare enrollment?

Accepted Answer

You'll face higher premiums as penalties. Part A penalty is +10% per year you delay, applied for twice the years skipped. Part B penalty is +10% per year delay, lasting as long as you have Part B. You may still sign up during certain Special Enrollment Periods.

Question 4

What does Medicaid offer for Medicare enrollees with limited income?

Accepted Answer

You may qualify for help with Medicare premiums and cost-sharing. Medicaid can cover services Medicare doesn't, like long-term nursing care, eyeglasses, hearing aids, and more.

Question 5

Who are dual eligibles and what benefits do they get?

Accepted Answer

Dual-eligibles qualify for both Medicare and Medicaid. Medicare pays first for most services. Medicaid covers gaps, including long-term care. Some get full Medicaid benefits; others receive help only with Medicare costs.

Question 6

Does Medicare cover assisted living or nursing home care?

Accepted Answer

Assisted living is generally non-medical and not covered. Medicare may pay for needed medical services within such a facility if deemed medically necessary. For nursing home care, Medicare covers only short-term stays after a qualifying hospital stay, not long-term custodial care.

Question 7

What home health services does Medicare cover?

Accepted Answer

Medicare covers part-time or intermittent skilled nursing care, physical therapy, speech-language pathology services, and continued occupational therapy. These services must be ordered by a doctor and provided by a Medicare-certified home health agency.

Question 8

Does Medicare cover hospice care?

Accepted Answer

Yes, Medicare covers hospice care for terminally ill patients who choose palliative care instead of curative treatment. This includes pain management, counseling, and support for the patient and their family. Care can be provided at home or in a hospice facility.

Question 9

How does Medicare Part D work and what is the late enrollment penalty?

Accepted Answer

Medicare Part D adds prescription drug coverage to Original Medicare through private insurance companies. You can enroll during your Initial Enrollment Period or Annual Enrollment Period (October 15 - December 7). The late enrollment penalty increases your premium if you don't sign up when first eligible and go without creditable coverage for 63+ days.

Question 10

What is Medicaid estate recovery?

Accepted Answer

Medicaid estate recovery allows states to recover costs from deceased Medicaid beneficiaries' estates. This typically applies to those who received long-term care services and whose assets exceed certain limits. States may place liens or seek reimbursement after death.

Question 11

What key Medicare updates should seniors know for 2025 and 2026?

Accepted Answer

In 2025, the standard Medicare Part B premium is projected to increase, with changes to Medicare Savings Programs income thresholds. The Inflation Reduction Act will impact prescription drug costs with out-of-pocket expense caps. In 2026, expect Medicare Advantage plan adjustments and expanded telehealth services.

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