Health insurance can be complicated, and Medicare is no different. If you have gone most of your life with health insurance provided by an employer or spouse, you may not have had much to think about. As you get to the age where you need to choose a Medicare plan or change the one you have, it can be stressful and confusing. You may receive countless advertisements enticing you to choose one plan over another.
Jump ahead to these sections:
- Where to Get Help If You Have Questions About Medicare Programs
- Where to Get Help If You Need Help With Costs Associated With Medicare
To be fully informed about your choices for Medicare, it will take some time to educate yourself about options and find the best fit for your situation. Plan on setting time aside to check out places to get free help with Medicare.
Give yourself plenty of time before any kind of deadline for deciding, so you aren’t choosing under stress. For example, in 2022, the open enrollment for traditional Medicare runs from October 15th to December 7th. If you’re already enrolled in a Medicare Advantage plan and want to change, you have between January 1st and March 31st.
Where to Get Help If You Have Questions About Medicare Programs
If you have questions about Medicare programs, it’s best to go to reliable sites with verifiable information. This is because commercial sites may have an interest in selling you Medicare Advantage plans or Medigap plans, which may or may not be in your best interest. As you consider long-term care costs, you will want to choose your plan wisely.
Medicare.gov is a website operated by the federal government. The government also administers original Medicare. Medigap plans are supplemental policies to Medicare A and B that private insurance companies run.
Medicare Advantage (MA) plans are administered solely by private insurance companies that Medicare approves. The Medicare.gov site has improved its user interface and includes information related to the following:
- Medicare basics. Medicare basics include the different parts of Medicare, including Medicare A and B and what each covers. It also goes over original Medicare and Medicare Advantage plans (also called Part C), the difference between Medicare and Medicaid, and Part D Medicare drug coverage.
- Medicare costs. The Medicare cost section provides a detailed analysis of Medicare Part A and Part B premiums and applicable deductibles.
- Signing up. The signup section is crucial due to penalties for late signup to Medicare. This part of Medicare.gov also covers topics like signing up if you are overseas and situations where an employer-sponsored health plan may still protect you.
- Coverage options. This section walks you through Medigap, Medicare Advantage, and prescription plans. There is a link to compare plans in your area since Medigap plan availability will vary depending on where you live.
- How to use medicare. There are distinct differences in using original Medicare and a Medicare Advantage plan. MAs are managed care plans with out-of-pocket costs for out-of-network providers and co-pays for some services. This section helps you distinguish between the two programs. Many people choose MA plans due to their low- or no-cost premiums, but it is crucial to understand the limits to MA coverage and co-pays as you consider this option.
Any AARP member has undoubtedly received numerous ads for AARP-sponsored Medicare Advantage plans. However, AARP does an excellent job explaining the differences between Medicare plans on their site. The information is not as detailed as Medicare.gov, but their site provides an easy-to-read description of the parts of Medicare, how Medicare works with other health insurance coverage, costs, and types of plans.
3. Health insurance brokers
You may have heard of health insurance brokers and health insurance agents. The difference between an agent and a broker is that an agent generally works on behalf of one insurance company. A health insurance broker is usually an independent licensed professional who works with several companies, including Medicare.
Health insurance brokers are free for the consumer but compensated by the insurance company you decide on. A good health insurance broker can save you time and possibly money by doing all of the investigative work for you and assessing the following:
- Whether you’re choosing a Medicare plan for the first time or want to change your plan
- Your current medical expenses, physicians, and other healthcare providers
- Whether you take prescription drugs, what they are, and the costs.
- Your budget
- Whether you’re currently employed and/or have coverage through a spouse
- Your pharmacy preferences
The insurance broker should present you with options such as MA, preferred provider organizations (PPO), original Medicare and Medigap plans based on their assessment of your needs.
4. US News and World Report Best Medicare Advantage Plans of 2022
US News and World Report offer a state-by-state comparison of Medicare Advantage plans for 2022. Their methodology relies on the Centers for Medicare and Medicaid Services (CMS) star ratings. However, the CMS star rating system has come under criticism in the past, so do as much review work on your own as you can to verify their recommendations. Each state has different Medigap and Medicare Advantage plans, and the US News and World Report have guidance for each state.
Where to Get Help If You Need Help With Costs Associated With Medicare
There are costs associated with Medicare, including premiums. Most help paying for Medicare premiums is income-based, and if you’re below a certain income and asset threshold, you can apply for Medicaid through your state Medicaid office. But if you don’t qualify for Medicaid, additional help is available to you.
5. Qualified Medicare Beneficiary (QMB) program
The QMB program has monthly income limits for individual and married couples to qualify. The program assists people with paying for Part A and B premiums, deductibles, co-insurance, and copayments for Medicare-covered services.
6. Specified Low-Income Beneficiary (SLMB) program
The SLMB program is a federal program administered by the states to help pay for Medicare Part B premiums. There are income limits to qualify.
7. Qualifying Individual (QI) program
The QI program assists individuals with paying for Part B premiums only through their state. You have to apply every year, and qualifying is first-come, first-served. You cannot qualify for the QI program if you are on Medicaid.
8. Qualified Disabled and Working Individuals (QDWI) program
The QDWI program is for disabled individuals who are working. The program assists with paying Part A premiums only, and you have to be under the age of 65. People under the age of 65 and on disability for a minimum of two years can qualify for Medicare. There are income limits.
9. State Health Insurance Assistance Program (SHIP)
SHIP are state-sponsored programs that provide local insurance counseling and assistance to people who need help paying for and understanding Medicare. SHIP can help you consider changes during the open enrollment, Medicare’s eligibility requirements, how Medicare works in concert with other health insurance plans, and assistance programs if you struggle to make premium payments.
10. Extra Help
Extra Help is a Medicare program to help people with limited income pay for Medicare prescription drug program costs. In general, if you qualify for Extra Help in 2022, you will pay no more than $3.95 for a generic drug and $9.85 for a brand-name drug.
11. Centers for Medicare and Medicaid Services (CMS)
CMS is the part of the Department of Health and Human Services that administers Medicare and Medicaid. On the CMS site, you can find general information related to Medicare and Medicaid, but for the most recent information on Medicare, turn to Medicare.gov.
Medicaid has complicated and state-specific income and asset qualifications. But if you do qualify for Medicaid, it can help with Medicare costs by:
- Medicaid is always the secondary payor source so that it can act as your secondary insurance paying for any co-pays and deductibles.
- Medicaid may pay your Medicare Part B premium.
- Medicaid pays for cost-sharing help if you also qualify for QMB.
- Medicaid can provide prescription drug assistance since people on both Medicare and Medicaid are automatically enrolled in the Extra Help program.
- Medicaid can pay for nursing home care if someone needs it.
Free Help with Medicare for Older Adults in 2022
Medicare can be a cost-saving health insurance plan but is complicated to understand. As you approach the time to sign up for Medicare or change your coverage, finding and using reliable free resources is the key to making a sound decision on your health care.