Five Positive Facts About Original Medicare

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Knowledgeable Aging

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Posted on

Oct 05, 2023

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Florida - Southwest

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The transition to Medicare is a wonderful opportunity to enjoy health care benefits when you are 65 and older, or have a disability or medical conditions that provide you with coverage when you are under the age of 65. To help you learn more about this program and prepare for enrollment, here are five positive facts about Original Medicare that you may enjoy discovering.

You Can Access Original Medicare Healthcare Benefits Throughout the United States and Its Territories

If you have Original Medicare, medical coverage is available in all 50 states and the District of Columbia in the U.S., and in its inhabited territories, including American Samoa, Guam, the Northern Mariana Islands, Puerto Rico and the U.S. Virgin Islands. In the event you require medical care while traveling, it’s important to know that most doctors and hospitals accept Original Medicare within these areas. If you’re outside of the United States, you may not get the same coverage. Original Medicare typically doesn’t cover any medical treatment you receive while outside of the United States, except under the following circumstances:

  • You require emergency medical care in Canada while you are traveling a direct route between Alaska and another contiguous state, and the closest medical center is in Canada.
  • You board a cruise ship and require medical care while you are in U.S. territorial waters. This includes the ship docking in a U.S. port or being within six hours of arrival or departure from a U.S. port.
  • You require non-emergency medical inpatient services in a foreign hospital, and the nearest foreign hospital is closer to your residence than the nearest U.S. hospital.

In these instances, Original Medicare may cover your medical care outside of the United States. Make sure you have this information handy before traveling abroad.

You Do Not Need Referrals for Covered Services Under Original Medicare

One of the biggest benefits that comes with Original Medicare coverage is that there is no need for referrals. Since Original Medicare encompasses Part A hospital coverage and Part B outpatient/medical coverage, beneficiaries can select any doctor that accepts Medicare for their treatment needs. Therefore, under your Original Medicare plan, you’re free to select the doctors and specialists you consult with at the hospital or healthcare facility of your choice for your medical needs. As long as the selected practitioner accepts Medicare, you’re good to go.

Beneficiaries Can Select and Change Medicare Benefits Every Year

There are two annual periods when Medicare beneficiaries can change their benefits: the Annual Enrollment Period (AEP) and the Open Enrollment Period (OEP). During the AEP, which runs from October 15th to December 7th, Medicare beneficiaries can:

  • Change from Original Medicare to a Medicare Advantage plan
  • Change from a Medicare Advantage plan to Original Medicare
  • Change from one Medicare Advantage plan to another
  • Enroll in Part D prescription drug coverage
  • Change from one Part D prescription drug plan to another
  • Cancel their current Part D coverage

Any changes made during AEP will take effect on January 1st of the next calendar year.

OEP, on the other hand, is a little bit different. The Medicare Advantage Open Enrollment Period, which applies to those currently enrolled in a Medicare Advantage plan, runs from January 1st through March 31st. During the OEP, Medicare beneficiaries can:

  • Enroll in a new Medicare Advantage plan (with or without Part D prescription drug coverage)
  • Disenroll from a Medicare Advantage plan and return to Original Medicare and enroll in a stand-alone Part D prescription drug plan

Medicare Allows Coverage Adjustments When Major Life Events Occur

In addition to AEP and OEP, Medicare also includes a Special Enrollment Period (SEP) that allows beneficiaries to delay initial enrollment in Parts B and D without incurring a late enrollment penalty (LEP) or change coverage outside of designated enrollment periods without incurring penalties or gaps in coverage. Special circumstances that allow for SEP include:

  • Loss of employer coverage
  • Moving out of your Medicare plan’s service area
  • Residing or moving in/out of a skilled nursing facility
  • Losing or gaining eligibility for Medicaid coverage

In these situations, an SEP grants delayed enrollment without penalty or Medicare coverage changes to assist beneficiaries in enrolling and managing their Medicare benefits. Documentation of said circumstances is required to create the Special Enrollment Period. It is highly recommended that you verify your eligibility for an SEP.

Medicare Can Be Less Expensive Than Previous Healthcare Coverage

You Could Save Money by Enrolling in Medicare If You Are Working Past 65 for a Large Employer (Over 20 Employees)

Medicare costs, premiums, deductibles, copays and coinsurance can oftentimes be less than many employers anticipate. It is important to carefully compare your current plan premiums, deductibles and maximum out-of-pocket costs to get an accurate assessment of both options.

For most, Medicare Part A is premium-free due to paying taxes while working. However, Part B requires a monthly premium; this cost can increase with your income. Understanding the Part B surcharge, known as Income Related Monthly Adjustment Amount (IRMAA), is important since added costs up to $450 per month.

For out-of-pocket costs, Medicare Part B has a very low deductible of $226 for 2023, and the coinsurance after this is just 20% for the Medicare beneficiary. However, it is important to note that Medicare Parts A and B do not have an out-of-pocket maximum limit, so considering a Medicare supplement plan can be helpful in covering your exposure to claims. Even without an out-of-pocket maximum, Medicare is still a cost-effective choice that can offer beneficiaries savings when compared to large employer-sponsored heath coverage plans.

If you need individualized assistance with your transition to Medicare or to a different plan such as Medicare Advantage or Part D prescription coverage, you’re in the right place. Contact Medicare Portal today for one-on-one help exploring suitable plan options – schedule a virtual, phone or in-person consultation with one of our licensed Medicare insurance agents today.

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Happiness At Any Age

Happiness At Any AgeStart your journey to joy now in your 60s, 70s, 80s, 90s, and beyond with these simple and effective exercises, strategies, and positive insights.Living happily in any decade involves an open heart, open mind, and appreciation for the joy in the journey. While everyone is unique, heres a guide to enjoy life in your 20s, 40s, 60s, 80s, and beyond.In your 20s & 30s Embrace uncertainty. This is the time for trial and error. Try new things and take risks, even if they feel scary. Build connections. Your social network can be a source of support, advice, and shared experiences both now and as you get older. Learn how to learn. Develop a growth mindset. Teach yourself that its ok to feel silly as you learn new things. Itll set the stage for lifelong learning. Build healthy habits. Establish healthy habits early. Try to move your body, eat well, and sleep well. In your 40s & 50s Balance work and life. Prioritize time with your family and friends. Work hard in your professional life. But don't forget to find joy in the little things. Plan your finances. Establish good financial habits. Save and invest in your future. Spend less than you make. Financial stability contributes to your peace of mind. Practice gratitude. Take time to appreciate what you have. Thank those who help you and contribute to others in a positive way. Build a mindset that's all about gratitude. Be open to change. Life is always changing, so it's a good idea to be open to all the curves along the way. Being able to adapt to everyday life is a skill that will serve you well in the future. In your 60s & 70s Reassess your goals. That thing you always wanted to do one day? Do it now. Adjust and modify your goals to include the steps itll take to reach that dream. Start working on writing that book, taking that trip, or even reaching a health and wellness goal to keep a positive mental attitude going. Add in some adventure. Remember, theres no age limit to new adventures. Happy thoughts and actions can even make you more likely to try new things. Go for new activities, try new recipes, or make new friends as an adult. These ideas keep your sense of play alive and well. Nurture old and new relationships. Improve relationships by focusing less on long-held disagreements. You don't get any points for winning arguments. Letting go of the past paired with self-compassion exercises can help you move forward. Mentor others patiently. Share your experiences and wisdom with others. Remember to be kind and patient by listening without judgment and putting yourself in their shoes. Someone out may need you to guide them in a way that only you're capable of. In your 80s & 90sMake time for the small things. Love spending time with your family? Make an effort to engage in the small activities you enjoy every weekor even daily! This can lead to an overall positive mental attitude later in life.Keep learning. Nows the time to try that new hobby youve always wanted to or pick up an old one. Even making friends as an adult or participating at a senior center near you can lead to a sense of joy. Plus, learning new skills keeps your brain sharp.Be kind to yourself. Listen to your body and give it what it needs. Go for a quick walk outside. Eat healthy foods. Embrace each day as a chance to live the life you desire, regardless of your age.  This article is contributed by Devoted Health.  Contact your local Devoted Health Representative at 251-391-3788 to find out how you could save with a Medicare Advantage Plan.

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