1. How will my current health insurance work with Medicare? If you are still working or recently retired, there’s a good chance you already have a private health insurance policy. This may make you hesitant to sign up for Medicare because you’re unsure of how the two different policies will interact. Not to worry – private health insurance and Medicare work hand in hand, and having Medicare on top of your existing coverage can further reduce your medical bills. A Medicare agent will be able to work with you to determine how much coverage you currently have and how much extra coverage Medicare will provide for you.

2. Am I eligible for Medicaid? Again, many people assume that Medicare and Medicaid (TennCare in Clarksville and Tennessee) is the exact same thing, or that if they receive Medicare they are not eligible for Medicaid. In fact, it is common for a person to receive benefits from both at the same time. These people are called dual eligibles, and there are nearly 10 million people in the United States who currently receive benefits from both. Based on your income and financial resources, your Medicare agent can help you determine if you also qualify for Medicaid.

3. How does vision coverage work on Medicare? Standard Medicare doesn’t provide coverage for eyeglasses or contact lenses. However, Medicare will help pay for these after cataract surgery (up to 80% of the total costs). Medicare also covers a single glaucoma screening every 12 months for anyone who is considered high risk for the disease, including people with diabetes, a family history of glaucoma, and African-Americans age 50 or older.

4. Does Medicare provide coverage if I leave the United States? Generally, Medicare does not provide coverage to people who are traveling outside the U.S. Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa and the Northern Mariana Islands are all considered part of the United States. Some Medicare Advantage plans do, however, provide coverage throughout the world if you are traveling and need medical assistance. This can vary depending on individual providers, so it is important to double check before you leave the country.

5. Can I still receive Medicare if I am already getting Social Security Disability benefits?
Yes. Anyone who has received disability benefits for at least two years is also eligible to receive Medicare. The two year period starts the same month you are first deemed eligible to receive disability benefits

6. Can I receive home health care treatment with Medicare? If you have Medicare, you are entitled to home health treatment if you meet all of the following criteria: your doctor must decide that you need medical care at home; you must be in need of frequent skilled nursing care or physical therapy; the home health agency that will be taking care of you must be Medicare-approved and certified; and finally, you must be considered homebound (unable to leave your home without reasonable assistance).
If you do meet all of the above criteria, you will be eligible for the following
- Skilled nursing care on a part-time basis or intermittent basis.
- Home health aide services on a part-time basis. This includes help with such activities as bathing, dressing, and other personal needs.
- Physical therapy for as long as your doctor says you require it.
- Medical social services to help with emotional concerns relating to your illness or condition.
- Certain medical supplies, including wound dressings, walkers, and wheelchairs.

-Do consult a local Clarksville Medicare agent before you make a decision. Medicare is confusing enough, and adding Medicare Supplements and additional coverage can sometimes make the process overwhelming. A qualified agent can work with you in finding the right supplements for your specific needs.

-Don’t buy supplements if you have a Medicare Advantage plan. Buying a Medigap policy when you already have a Medicare Advantage plan is counter-productive, as only one can be utilized at any given time.

-Do review your policy carefully both before and after you sign it. If you notice something out of the ordinary or something you are not comfortable with, you have a free trial period of 30 days to test the service. If you are unhappy for any reason, you can return it within this time period with no commitments.

-Don’t buy more coverage than you need. Some insurance companies and agents may try to sell you on buying additional coverage that goes beyond what you require. If you are in good health and aren’t currently on prescription medications, Medicare Part A may be sufficient for your needs. If you decide to additional coverage, you can do so during the annual enrollment period from mid October through mid December each year. A Clarksville Medicare agent can help you determine the amount of coverage you need for your specific healthcare needs.

Medicare Advantage plans and Medicare Supplements each have different criteria for allowing a person to enroll. Generally, if a person is eligible for standard Medicare, he or she will be eligible to receive Medicare Advantage.

Medicare Supplements, or Medigap policies, allow for open enrollment for anyone who has turned 65 within the past six months or has just signed up for Medicare Part A and B. Outside of this window of time, patients may be required to undergo a medical screening and obtain a recommendation from a physician before they are eligible to enroll.

Medicare Advantage is similar in that almost anyone who is eligible for Medicare Part A and B is also eligible to enroll, but there is one exception: patients with ESRD, or End Stage Renal Disease, do not qualify for Medicare Advantage. It is also important to fully understand the rules and regulations of any current health insurance plans you may have, as your coverage may be dropped if you enroll in the Medicare Advantage plan.

It is important to note that Medigap and Medicare Advantage plans cannot be used at the same time.

While Medicare Part A is typically free to most citizens 65 and older, adding additional coverage can constitute significant increases in the amount of monthly premiums a patient is required to pay. For example, as of 2011, Medicare Part B currently costs anywhere between $96.40 and $115.40 for most citizens, depending on income level and tax status.

Adding Part D, or prescription drug coverage, increases a patient’s monthly premium as well, although this is typically offset by the amount of money the patient saves on his or her medication. Currently, patients are responsible for a $310 deductible and 25% co-payment for prescription drug costs up until they hit a coverage limit of $2,830. Once the coverage limit is reached, patients must pay any extra costs out of pocket until they hit a ceiling of $4,550. Then, any extra medication expenses are considered “catastrophic coverage” and a patient must pay either a 5% co-payment or a flat-rate for either a generic or a brand name prescription.

Adding extras to a standard Medicare plan like Medicare Advantage can bring the overall cost of the plan down, but they can also bring about hidden charges that patients should be aware of. For example, Medicare Advantage plans have a lower premium than just Medicare Part A and B, but patients are required to pay a larger co-payment after receiving treatment. They are also restricted to a specific Medicare approved network of treatment facilities in Clarksville and across the country.

Medigap policies are another optional addition to Medicare that are almost the opposite of Medicare Advantage – instead of decreasing monthly premiums, they increase it. However, they can greatly reduce or even eliminate a patient’s co-payments. They also offer freedom for the patient to pick and choose which doctor or hospital to visit without worrying about it being in the approved network.

Medicare and Medicaid sound extremely similar, and in fact their general purpose is almost exactly the same: They are both government sponsored public health programs designed to provide assistance for specific groups of U.S. citizens who require medical treatment. However, Medicaid receives funds from state governments rather than exclusively from the federal government. Because of this, each state controls its own form of Medicaid, and some may even assign a different name for it. For example, Clarksville and Tennessee residents may recognize it as TennCare.

Medicaid is available to low income citizens regardless of their age or disability status. Individuals are assessed according to their monthly or yearly income and their overall financial resources. Also unlike Medicare, children represent a sizeable percentage of Medicaid beneficiaries, and children can be eligible to receive benefits even if their parents are not.

Medicaid has more extensive coverage and benefits than standard Medicare. Most physician/hospital visits are paid for by Medicaid, although patients are typically still responsible for a small co-payment, depending on each individual state’s policy. Prescription drugs are also available for recipients of Medicaid.

Current recipients of Medicaid may still be eligible to receive Medicare and vice versa. It’s important to consult a Clarksville Medicare agent to check your status in order to verify whether you can obtain coverage from both, as each complements the other and can go a long way to reducing medical expenses.

Medicare was first approved by President Lyndon B. Johnson on July 30, 1965 as a way to give free healthcare to America’s elderly population. Just as it was in 1965, Medicare today is a federally funded public health program that is available to any Clarksville resident or United States citizen who is 65 years of age or older who has been a citizen of the country for at least ten years and has been employed for at least five. Medicare is also available to certain individuals with disabilities, including end-stage renal disease.

It is financed by income taxes taken out of every paycheck issued in the country. Those funds are then used to pay for a person’s own Medicare enrollment when he or she turns 65.

Medicare is split into four main parts, with each having its own individual area of coverage.

Medicare Part A is also known as hospital insurance, and it is considered the most basic of all Medicare coverage. It is available to anyone who is eligible for Medicare, and provided they have paid at least 10 years of income taxes, they can enroll in it for free. Because it is considered to be “bare bones” coverage, however, it only pays for certain medical expenses – typically, this includes hospitalization, hospice and short-term stays in a nursing facility (up to 100 days).

Medicare Part B is known as medical insurance, and it adds another dimension of coverage to standard Medicare. With Part B, Clarksville patients will receive assistance for outpatient needs, including routine doctor visits and laboratory testing, like x-rays, blood tests, and vaccinations. Part B also assists patients with medical equipment costs for supplies like canes, walkers, and wheelchairs.

Medicare Part D is known as prescription drug insurance, and does exactly as its name implies: it covers a patient’s daily, monthly, and yearly costs for their prescription medications. It is a recent addition to Medicare, being approved in Jan 2006. It can be added to any existing Medicare plan, and unlike Part A and B, it is not standardized, which means patients can choose from different plans which may cover different prescription drugs. However, all plans exclude certain classes of medications, including weight loss drugs, fertility drugs and certain painkillers.

Medicare Part C is also known as Medicare Advantage, and it is a combination of Part A and B. Patients also have the option to add Part D as well. Medicare Advantage (also known as Medicare HMO or PPO) is offered by Medicare-approved private insurance companies in Clarksville and across the country. With Medicare Advantage, patients have access to a number of benefits that may not be present under a typical Medicare coverage plan, including dental and vision insurance. Some Advantage plans include health club memberships and special disease management programs as well.

However, unlike standard Medicare, Medicare Advantage plans require that a patient only utilize certain doctors and hospitals that are part of a special approved network. Receiving treatment at a facility outside of this network can result in extra fees and expenses. Clarksville residents who purchase a Medicare Advantage plan should consult a Medicare agent to find out which treatment facilities are in their network.