Medicare Step 4: Use your Medicare

Using Medicare involves understanding your coverage, knowing how to access services, and managing the associated costs. Here’s a step-by-step guide to help you effectively use your Medicare benefits:

1. Get Your Medicare Card

• Once enrolled, you will receive a red, white, and blue Medicare card. This card is essential for accessing your benefits.
• Keep your card safe and bring it to all medical appointments.

2. Understanding Your Coverage

• Part A (Hospital Insurance): Covers inpatient hospital care, skilled nursing facility care, hospice, and some home health services.
• Part B (Medical Insurance): Covers outpatient care, doctor visits, preventive services, and some home health services.
• Part C (Medicare Advantage): Provides all Part A and Part B benefits and often includes additional benefits like dental, vision, and prescription drugs.
• Part D (Prescription Drug Coverage): Covers prescription medications.
• Medigap (Supplemental Insurance): Helps cover out-of-pocket costs not covered by Original Medicare.

3. Using Your Medicare Coverage

• Doctor and Hospital Visits:

  • Make sure your healthcare provider accepts Medicare.
  • Show your Medicare card at appointments.
  • If you have a Medicare Advantage plan, use providers within the plan’s network to avoid extra costs.

• Prescription Drugs:

  • Present your Medicare Part D or Medicare Advantage plan card at the pharmacy.
  • Use pharmacies in your plan’s network to minimize costs.

• Preventive Services:

  • Take advantage of preventive services covered by Medicare Part B, such as screenings, vaccines, and annual wellness visits.

4. Managing Costs

• Understand Your Bills:

  • You will receive Medicare Summary Notices (MSNs) or Explanation of Benefits (EOBs) if you have a Medicare Advantage plan, detailing what Medicare paid and what you owe.
  • Review these documents for accuracy and contact your provider or plan if there are discrepancies.

• Paying Premiums:

  • Pay your Part B premium (and Part A if applicable) on time.
  • Pay any additional premiums for Part D, Medigap, or Medicare Advantage plans.

5. Appealing Denials

• If Medicare or your plan denies a service or claim, you have the right to appeal.
  • Review the denial notice for instructions on how to appeal.
  • Gather any supporting documents from your healthcare provider to strengthen your case.

6. Switching Plans

• Annual Open Enrollment Period: From October 15 to December 7, you can switch between Original Medicare and Medicare Advantage, change Part D plans, or join a new plan.
• Medicare Advantage Open Enrollment Period: From January 1 to March 31, you can switch Medicare Advantage plans or revert to Original Medicare.

7. Getting Help

• Medicare Website: Use Medicare.gov for resources, plan comparisons, and finding providers.
• State Health Insurance Assistance Program (SHIP): Get free, personalized counseling about Medicare options and benefits.
• Customer Service: Contact Medicare at 1-800-MEDICARE (1-800-633-4227) for assistance.

8. Using Extra Benefits

• If you have a Medicare Advantage plan, take advantage of additional benefits such as dental, vision, hearing, and fitness programs. Check your plan details to understand what’s available and how to access these services.

Summary

• Show Your Card: Present your Medicare card at all medical visits.
• Check Coverage: Confirm that services and providers are covered.
• Understand Costs: Review bills and notices for accuracy and understand your share of the costs.
• Use Preventive Services: Take advantage of covered preventive care to maintain your health.
• Get Help: Utilize available resources for guidance and assistance.

By following these steps, you can effectively use your Medicare coverage to access necessary healthcare services and manage your healthcare expenses.