15 Medicare Facts You Need to Know

Millions of older Americans get health benefits through Medicare, and the more you know about the program, the easier it’ll be to make the most of it. Here are 15 key facts about Medicare you should be aware of, whether you’re newly enrolled or are simply planning for the future.

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Unless you qualify for earlier enrollment based on a specific health issue, you can expect your Medicare benefits to kick in at 65. But enrollment won’t happen automatically. You’ll need to actively sign up for Medicare to get coverage.

ALSO READ: 5 Medicare Surprises That Could Wreck Your Retirement

Your initial Medicare enrollment window begins three months before the month of your 65th birthday, and it ends three months after that month. If you don’t sign up during that period, you’ll need to wait until Medicare’s general enrollment period, which runs from Jan. 1 through March 31 annually.

To enroll in Medicare, you’ll need to create an account on the Social Security Administration’s website and fill out some information. At the time you sign up, you’ll be asked if you wish to start collecting Social Security as well. But that doesn’t mean you have to claim your Social Security benefits. In fact, you may be better off not doing so if you’re enrolling at or around age 65, since that’s before full retirement age for Social Security purposes.

Though Medicare Part B, which covers outpatient care, charges enrollees a monthly premium, Part A, which covers hospital visits, is usually free. It’s possible to enroll in Part A without signing up for Part B.

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Although you probably won’t pay a monthly premium for Part A, that doesn’t mean hospital care under Medicare is free. Effective Jan. 1, you’ll pay a $1,484 Part A deductible for each hospital stay, plus daily coinsurance if your stay extends beyond 60 days.

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Medicare enrollees are entitled to a host of no-cost preventive care services, including an annual physical, mammograms, and depression screenings. It pays to take advantage of these benefits, especially since doing so could help you get ahead of costlier health issues.

Medicare Part B charges a standard monthly premium that changes from year to year. Right now, it’s $144.60 a month, but come Jan. 1, it will be $148.50. Higher earners, however, pay more for Part B.

ALSO READ: Should I Sign Up for Medicare or Keep My Employer's Plan?

Going without Medicare Part B for too long could cost you. For each 12-month period you’re entitled to enroll but don’t, you’ll face a 10% surcharge on your monthly premiums. That could make your coverage a lot more expensive throughout retirement.

Medicare eligibility doesn’t hinge on your employment status. If you’re still working at age 65 but want Medicare, you’re entitled to enroll. Some people, however, may choose to sign up for only Part A in that situation and retain their employer coverage as well.

Health savings accounts, or HSAs, let you contribute funds for medical spending in a tax-advantaged manner. But once you enroll in Medicare, you can no longer put money into one of these accounts. You can, however, take withdrawals to pay for healthcare as a Medicare beneficiary.

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One drawback of Medicare is that it doesn’t cover a number of common healthcare expenses, and dental care is one of them. If you need routine dental care, like a cleaning or cavity filling, you’ll need to pay out of pocket. That said, many Medicare Advantage plans do cover dental care, so opting for one instead of original Medicare could be a smart move.

ALSO READ: 4 Last-Minute Medicare Open Enrollment Tips

A large number of seniors wind up needing long-term care in an assisted living facility or nursing home, but unfortunately, Medicare won’t pick up the tab there. It’s a good idea to secure long-term care insurance during your 50s or early 60s so you’re not left with exorbitant out-of-pocket costs later in life.

Some seniors opt to stay on the same Part D drug plan for years, but one thing you should know is that plans are allowed to change from one year to the next. And if that happens, your prescription costs could skyrocket. Always read your Part D plan’s annual notice of change so you can see whether you’ll be impacted and whether it pays to switch to a new plan.

Many seniors struggle with mobility issues that make getting to and from medical appointments a challenge. Thankfully, Medicare will cover telehealth visits so enrollees can access care from the comfort of home. That’s been especially important during the coronavirus pandemic.

ALSO READ: Could a Medicare Advantage Plan Help You Live Longer?

Though it’s too soon to know exactly when a coronavirus vaccine will become widely available to seniors, the good news is that Medicare will pay for it once it arrives. As a result, the vaccine should be free for enrollees.

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There’s a lot to learn about Medicare, and if you plan to rely on the program for health benefits, it’s worth making that investment. Reading up on how Medicare works could help you choose the right coverage, sign up at the appropriate time, and take advantage of the many services Medicare has to offer.

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