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What Is Medicare?

Though complicated and costly, the federal insurance program helps older Americans afford the health care vital to their well-being

highlighter pen on a medicare enrollment form

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What is Medicare? For 55 years, it's been the program that older Americans and people with disabilities turn to for their health care coverage. In 2020, it will help more than 61 million people pay for everything from hospital stays to doctor visits to prescription drugs.

At 65, you become eligible for the program — which means you will need to set aside time around that milestone birthday to sift through many options so you can sign up for the coverage that meets your health needs and budget.

It's up to you to get ready. Unless you are already receiving Social Security benefits and then will be automatically enrolled in the program, you won't get a letter in the mail reminding you that it's time to start making these decisions. What's more, the timetable is specific — and important. You can start signing up three months before you turn 65, and you'll have until three months after your birthday month to enroll. If you miss that deadline, you may end up paying higher premiums. If you are still working and have employer-sponsored health coverage, you can probably wait to sign up — but more about that later.

Taking control of your health care

You'll need to do some homework before you start assessing options and picking plans. Make a list of your doctors and decide how important it is to you that you can continue seeing them once you are on Medicare. Also make a list of any medications you take so you can make sure any prescription drug plan you select will meet your needs.

Think about your lifestyle. Are you a homebody and never travel outside the U.S.? Or are you an adventurer who goes abroad frequently? Do you split your time between residences and need medical care in different states? All these factors are likely to figure into the decisions you make.

Your financial situation also is important. You'll learn through this guide that Medicare helps pay for medical care for older Americans and people with disabilities. But it's not free. You'll want to choose an option you can afford and build the array of out-of-pocket costs into your budget. And take time to review the ways the federal government can help you pay Medicare's costs if you can't afford them.

You need to pay attention to all of Medicare's parts: Part A covers hospital and hospice care and some skilled nursing services after you've been in the hospital. Part B includes doctor visits and other outpatient services. Part C is Medicare Advantage, which is a combination of Parts A and B — and usually Part D, which helps pay for prescription drugs.

Medicare adapts to the coronavirus

Medicare is also an evolving program. In 2020, Medicare officials have made changes in an effort to help enrollees cope with the needs and uncertainties brought on by the COVID-19 crisis.

For example, the federal government said early on in the pandemic that Medicare would cover the cost of coronavirus testing for beneficiaries and also decided that doctors could order tests be brought to enrollees’ homes and administered there.

Medicare had already expanded its coverage of telehealth in recent years, but the arrival of the coronavirus accelerated the use of remote care. Beneficiaries can now use any of their devices — a phone, tablet or computer — to communicate with their medical providers. Medicare will now cover telehealth visits with nurse practitioners, physical therapists and occupational therapists, in addition to doctors.

Now that you have a taste of what Medicare has to offer, take some time to gain a better understanding of this vital but complex health care program.

Do You Know Your Medicare Vocabulary? — AARP

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