Medicare is a federal health insurance program for individuals over 65 years of age , those with disabilities, or those with certain diseases like permanent kidney failure. In times of health emergencies, Medicare plans can provide a financial safety net to people by fully or partially covering their treatment costs. But, there are several conditions individuals must fulfill to be eligible for a Medicare plan. Not knowing these can lead to financial setbacks during health emergencies.

Things to know before choosing Medicare coverage

Medicare has different parts
Medicare has various parts. Part A, also called Hospital Insurance, covers inpatient hospital stays, care received in nursing facilities, and home care services to some extent. Part B, or the Medical Insurance, covers all expenses related to routine doctor visits, outpatient care, medical supplies, and preventive services. Medicare Part A and Part B are called the Original Medicare. Further, Part C is the Medicare Advant age plan that offers an alternative to Original Medicare, while Part D is the prescription coverage that covers the cost of recommended treatment options.

One can purchase Part A and B from the government, while Part C can be purchased directly from a private healthcare company. There is also the Medicare Supplemental Insurance or Medigap, which can be an add-on to the Original Medicare plan. Medigap helps cover costs that Original Medicare does not cover, like copays and deductibles.

Medicare has a team to address queries
One can sign up for Medicare through its official website. One can also compare plans on the website in one’s area and talk to agents to get the most suitable deal among all . Those who have queries related to Medicare plans can reach out to the sales team in their area or talk to Medicare brokers or advisors. They can not only resolve queries but also help one to get enrolled. Before picking a plan, it’s advisable to check what care and coverage one already has in one’s health insurance. Medicare plans can benefit if one wants a larger network of doctors or types of treatments. Then, one can start to narrow down the Medicare coverage.

Late enrollment penalty
In some cases, like a small employer plan with 20 employees or less, people are required to sign up for Original Medicare as soon as they’re eligible, or they may be subject to late enrollment penalty. So, one should confirm and prepare to sign up well in advance.

Original Medicare may not cover international travels
It’s important to have coverage at all times, including when traveling. Original Medicare usually covers healthcare visits only within the country and only when one sees a Medicare-approved provider. But, in case one is traveling abroad, the coverage may not apply. So, frequent travelers can take Medicare Advantage plans to cover emergency care during international travel. It’s best to run the plan through a Medicare advisor to know what is covered during travels.

Different plans have different costs and coverage
When choosing Medicare, consider both costs and coverage. Original Medicare doesn’t have a yearly limit on what one pays out of pocket, while Medicare Advantage does. It’s important to understand expenses like premiums, deductibles, and copays. Original Medicare covers basic services but not routine dental or vision care, while Medicare Advantage may offer more benefits. If one has other health coverage, check how it works with Medicare before making any changes.

Supplemental coverage option
One can buy supplemental coverage like Medigap to cover out-of-pocket expenses. One can also get certain coverage from the current employer or union , or Medicaid, which is an added healthcare benefit for low-income individuals and families. It’s important to know how much premium one will pay each month, the deductibles, and if one’s medical supplies will be covered if they are bought from the regular offline store or mail.

Additional benefits
Original Medicare plans do not usually cover hearing, vision, and dental care, but they are often required frequently. Some Medicare Advantage and Cost plans do cover these services, so it’s best to inform the Medicare advisor if one requires these services and learn about their inclusions while selecting a plan.

Different types of Medicare providers
The Medicare website offers tools to find and compare different types of Medicare providers in one’s locality. This search can help one make informed decisions about healthcare options and find providers that best suit their needs. Some common types of Medicare providers include:

• Doctors and clinicians who are a group of qualified practitioners specializing in certain conditions or body parts
• Hospitals, which provide a plethora of medical, surgical, and psychiatric care
• Acute care, which gives inpatient medical care for short-term conditions
• Children’s care, usually inpatient for those under 18 years
• Critical access, which gives limited inpatient and outpatient services in rural areas.
• Nursing homes, which have 24-hour care for short- or long-term requirements, including rehabilitation after surgery or for those with conditions like Alzheimer’s
• Hospice care, which gives all-rounder support to those with advanced, life-limiting illnesses
• Dialysis facilities for those with end-stage renal disease (ESRD) or kidney failure

Choice of doctor and hospital care
Generally, one can only access doctors and providers within the plan’s network and service area for non-emergency care. But , some plans may provide out-of-network coverage for non-emergency cases, which often comes at additional costs. So, one should check if their preferred doctor and hospital are covered in one’s Medicare plan . In some cases, it may be necessary to obtain a referral to consult with a specialist.