If you’re nearing the age of 65 or are already eligible for certain disability benefits, it’ll soon be time to put the taxes you’ve paid towards Social Security to good use and enroll in Medicare. Here’s an overview of what you need to know about your health coverage and what is available to you in Tennessee.

1. What is Medicare?

Medicare is a national health insurance program for individuals age 65+ that operates from the Federal Government’s Center for Medicaid and Medicare Services. The program was put in place to assist the elderly with hospital and medical costs. Some disability statuses recognized by the Social Security Administration and end-stage diseases can also qualify you for Medicare.

2. What’s the Difference Between Part A, B, C and D?

Part A – Covers inpatient care, skilled nursing care, hospice, and home health care.

Part B – Covers medical equipment, doctor or specialist care, outpatient services, preventative services such as screenings or shots, and home health care.

Part C – Also known as Medicare Advantage, this program is for those who need a lower cost bundle of Part A, B, and D. However, there are some restrictions such as you must go to a doctor within the network, may need a referral to see a specialist, and cannot buy supplemental coverage.

Part D – Covers some prescription drugs.

3. Is My Medication Covered?

Medication or Drug Coverage is not covered under Part A and typically not under Part B. Part D is in place for those who need coverage for medication, but you must actively apply to obtain coverage.

4. Do I Apply for Medicare or Am I Automatically Enrolled?

If you are receiving some form of social security benefits, then you are automatically enrolled in Part A and Part B when you are eligible. If you are not already receiving social security when you become eligible, then you need to apply either in person, online or over the phone by contacting your local social security office. However, if you want Medicare Part D then you must enroll yourself, as it won’t be done automatically for you.

5.  Is This The Same Process for Veterans?

Veterans receive Veterans Affairs (VA) benefits, but can also receive Medicare benefits when they are eligible. However, it’s important to know that they do not work together. So if a veteran goes to a VA facility, Medicare does not cover the treatment or care received. VA benefit plans have different priority levels so they will vary from person to person; for example, one person may have excellent VA drug coverage while another may opt-in for Medicare Part D.

6. How is Medicare Paid For?

The majority of Medicare comes from a percentage of your payroll taxes and general revenue that is contributed to the health care system. If you have paid into Medicare for 10 years (or 40 quarters), then Part A is free for you. If you have not met the 10-year minimum then you have to pay a premium for Part A. Part B requires a premium regardless.

7. Are There Medicare Discounts?

Not necessarily, but there are programs in place to help manage costs. Medicaid is a state and federal program for those on a limited income. There are also Medicare Savings Programs (MSP) put in place by each state. In Tennessee, we have a program called TN SHIP for Information and Counseling (http://tnmedicarehelp.com/).

8. When Do I Need Medicare Supplements?

If you are having trouble covering your medical expenses then medicare supplements, also known as Medigap, may be right for you. They are provided by private insurances to help cover costs such as copayments, deductibles, and coinsurance.

Read More: Do I Need a Medicare Supplement Plan?

9. Does Medicare Vary From State to State?

Yes and No. Part A and Part B are typically the same from state to state. However, Part C and Part D may vary depending on what type of coverage you have.

10. What Are My Medicare Rights?

Everyone covered under Medicare has the right to:

• Be treated with dignity and respect at all times.
• Protection from discrimination.
• Privacy in regards to personal and health information.
• Have information pertaining to your health care and services available in a manner you may understand.
• Have access to information you can understand in regards to your health care coverage, costs, and how to file a complaint, claim or appeal.
• Have your questions answered.
• Have access to hospitals, doctors, and specialists.
• Have the ability to participate in treatment decisions and have the information presented to you in a language you can understand and in a way that maintains respect for your culture.
• Receive care in an emergency (Medicare-covered services).
• Receive a decision about your payments, coverage, or prescription drug coverage.
• Right to file an appeal.
• Right to file a complaint or grievance.

If you or a loved one would like to learn more about Medicare or Supplemental plans or need help covering your medical costs, contact McInturff, Milligan & Brooks via the form below or at (423) 639-5171. We can help you figure out what is best for you.