Continental Health Alliance Blog

5 Medicare Rules You Need to Know

What is Medicare, and why is it such a big deal? As I am sure most of you know Medicare can be very confusing. This post will break down Medicare and provide you with some basic rules you should know. These rules will help you choose the right coverage that meets your needs. They will also guide you on how to sign up for benefits and avoid late penalty charges.

1. When can you apply for Medicare: Most people become eligible to receive Medicare when they turn 65. You can file an application for Medicare three months before your 65th birthday. It is always better to be prepared. If you’ve applied for Social Security benefits earlier than that, then your Medicare Part A coverage will typically automatically begin the day you turn 65. It is recommended that you apply for free hospital coverage under Medicare Part A.

Medicare Part B, which is medical care coverage, requires paying a monthly premium. If you have other sources of coverage, you may want to do more research before enrolling into the program.

2. Are there penalties for applying for Medicare late:Many people don’t realize that there are penalties when applying for Medicare too late. For Part B coverage, every 12 months that you go without enrolling when you were eligible, will send your monthly premiums up 10%. Part D prescription drug coverage penalties can also apply if you chose not to get a policy when you were first able to. It’s very important to do your research before you turn 65. You want to have an idea of what type of coverage you will need and what plans may benefit you the most.

3.What does Medicare Advantage plans offer that original Medicare doesn’t: Medicare Advantage plans, many refer to as Medicare Part C, offer benefits that basic Medicare doesn’t. Most Medicare Advantage plans are created to have more coverage than traditional Medicare, offering out-of-pocket maximums, different co-payments, and coinsurance options. Keep in mind, these plans can also have restrictions on which doctors you can see. Make sure you look closely at all your options and pick the one that best meets your needs.

4. When can you change your coverage: Annual enrollment periods allow you to switch between different Medicare plans. From October 15 to December 7, you can change between traditional Medicare and a Medicare Advantage Plan, or you can switch to a different Medicare Advantage plans. You can also make changes to your prescription drug coverage (part D coverage) during that time.

5. How can you deal with disputes over coverage: If Medicare makes a decision that you are not happy with, you have the right to file an appeal. You can seek a re-determination by the company handling claims for Medicare. If that doesn’t work, then a qualified independent contractor will reconsider the decision. Your next option is a hearing before an administrative law judge, and if that fails, then a Medicare Appeals Council can review the case. Finally, you have the right to take the case to federal court for a judicial review. I know this sounds like a lot of work, but it could save you a lot of money if you are dealing with a large claim.

I am hoping you found these tips educational and beneficial. Medicare can be very intimidating and often times confusing because of the legal jargon, which is hard to interpret. That’s why we exist, to help you navigate through the rough waters. If you have any questions or concerns, please contact us at 1-844-452-5020 and we will match you with an agent in your area.


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