1. How will my current health insurance work with Medicare coverage?
Your agent should be knowledgeable and up-to-date on all current health insurance plans offered in Shelby county and throughout the state, and will be able to assist you in deciding which plan will work best with your existing health insurance.

2. How much will my monthly premium be?
Monthly premiums vary depending on which plans you enroll in. For Part A, or hospital insurance, it is usually free as you have already paid into it during your years of employment. For Parts B, C, and D, additional premiums will be added. Your agent will help you review your current health status, coverage and budget to decide the plan that is right for you.

3. How much coverage will I need?
Depending on your overall health, your current health insurance and the amount of treatment you may require each year, the coverage you need could be anything from just Part A to Medicare Advantage combined with a prescription drug plan. Working with a Medicare agent can clear confusion when it comes to deciding which plans to enroll in.

4. Which doctors and hospitals are included in the network?
This is a topic that should be addressed with your Medicare agent and provider before you enroll in a plan. Residents of larger cities in Tennessee such as Memphis, Knoxville and Nashville will have more local options than residents of smaller, more rural areas throughout the state. For those patients, travel to in-network doctors may be required.

5. What happens if I get sick while away from my family doctor/hospital?
Under standard Medicare, you will be covered for treatment throughout the United States. With Medicare Advantage and other private HMOs, you may be required to seek attention from a more restrictive network of doctors and hospitals. Again, this concern should be discussed with your Medicare agent before deciding on a plan.

6. Is a referral required in order to see a specialist?
Many Medicare plans require that a patient see your General Practitioner within the approved network before the patient is allowed to visit a specialist. A Memphis Medicare agent will be able to assist you to determine whether you need to take this extra step while seeking specialized care.

7. Am I also eligible for Medicaid?
Just because you are enrolled in Medicare does not mean you are ineligible for Medicaid. Your Medicare agent should work with you to determine your eligibility to be covered under both Medicare and Medicaid (also known as TennCare in Memphis and throughout Tennessee). Medicaid is primarily issued on a financial need basis, and it is not uncommon for a person to be covered under both plans.

8. Will my rates ever go up?
Standard Medicare premiums do tend to increase slightly over time. This potential increase, combined with potential increases from certain Medicare HMOs should be addressed by your Medicare agent before you enroll.

9. Do I need to buy Medicare Supplements?
Some Memphis residents may feel standard Medicare coverage is sufficient for their needs, while others may require the more extensive coverage that Medicare Supplements can provide. The number of doctor visits you make each year and how frequently you need treatment should help you decide if Medicare Supplements are right for you.

10. Do I need separate dental and vision insurance?
Standard Medicare does not cover dental and vision treatment. Should you require these services, a Medicare agent will advise you to enroll in a Medicare Advantage plan which often includes these options.

A big worry for Memphis residents about having a Medicare plan is whether the monthly premium will ever increase. Current estimates through 2014 show that while Medicare premiums are in fact expected to increase, the total amount of the increase will be small. A study by the Center for Medicare and Medicaid Services projects Medicare premiums for Plan B to cost $108.20 in 2012, $112.10 in 2013 and $117.10 in 2014. Premiums could increase more if the Medicare recipient is in a high income bracket.

Medicare and Medicaid may sound extremely similar on the surface, but there are actually a number of key differences between them that all Memphis residents should know.

Medicare is available to any person 65 years of age or older who has been a United States resident for at least five years. It is also available to individuals with certain disabilities who are under the age of 65.

Medicare is divided into four different parts, each providing a different area of coverage and with a different cost associated.

The first part, or Part A, is called hospital insurance. It pays for overnight hospitalization and the subsequent fees associated with such treatment. It can also cover stays in nursing facilities for up to 100 days, with the first 20 days being paid in full by Medicare while the remaining 80 require a patient co-payment. Part A is provided with no cost to any Memphis or U.S. citizen 65 and older who has worked for 40 or more quarters in his or her lifetime.

The second part of Medicare, also known as Part B, is medical insurance. This optional coverage fills in the gaps left by Part A, and usually pays for work done during routine outpatient visits, including x-rays, blood work, vaccinations, ambulance transportation, etc. It also covers necessary medical equipment related expenses a patient may require, such as prosthetics, canes, and wheelchairs.

The third part, Part D, covers a patient’s prescription drug costs. It is a recent addition to Medicare and is available to anyone who is currently covered by Part A or B. It does not cover any drugs that have not been approved by the FDA, as well as most fertility drugs, weight loss drugs, certain pain medications and drugs designed for cosmetic purposes.

Finally, there is Part C – a customizable and more extensive plan also known as Medicare Advantage. With Medicare Advantage, patients are automatically enrolled in Parts A and B and also have the option to enroll in Part D. It is generally less expensive than the other plans due to a lower monthly premium, but individual co-payments after receiving treatment can be higher than with standard Medicare.

On the flip side of this, there is Medicaid.

Much like Medicare, Medicaid is a government-controlled health insurance program that provides support for patients requiring inpatient or outpatient services. Unlike Medicare, however, Medicaid is funded on the state level. For residents of Memphis and throughout the state of Tennessee, it is commonly known as TennCare.

Instead of eligibility for Medicaid being based strictly on age or disability status like Medicare, it is also dependent on a person’s income, overall assets, and citizenship. States are required to provide Medicaid services to low income individuals below the poverty line, as well as any person receiving federal income assistance. Some people can actually receive benefits from both Medicare and Medicaid at the same time.

In general, Medicare is available to anyone who is 65 years of age or older and who has been a resident of the United States for at least five years, provided either they or their spouse has paid Medicare taxes for 10 years.

It is also available to anyone regardless of age who has been diagnosed with a permanent disability or who has end-stage renal failure and is undergoing dialysis or requires a kidney transplant.

Although Medicare is a great asset for the aging population and for those with disabilities, it often is not enough to cover all of their medical expenses. While routine doctor visits and occasional hospitalizations are covered under Parts A and B, certain specialized treatments like podiatry care, chiropractic services and ambulance transportation are not.

In response to this need, private insurance companies in Memphis and throughout the country offer extended plans called Medicare Supplemental Insurance, sometimes called a Medigap policy, to help fill in those gaps in coverage.

While Medicare can and often does pay up to 80 percent of a patient’s medical expenses, the remaining 20 percent can still be a tremendous financial burden. Even routine doctor visits can add up over time, especially for those with chronic ailments like diabetes and high blood pressure who need frequent treatment. With Medigap, the patient typically won’t be responsible for any co-payments after seeing a doctor. However, it should be noted that Medicare Supplements do carry a heavier premium due to this benefit.

Medicare Supplements are also great for patients who are frequently away from their local hospital and doctors, as they operate network free, meaning patients can utilize any care center without worrying about penalties or extra fees.

Medicare Advantage is a combination of two standard Medicare offerings: Part A, also known as Hospital Insurance; and Part B, also known as Medical Insurance. Most Medicare Advantage plans also cover prescription drug costs, or Medicare Part D. Some plans even include dental, vision and hearing coverage as well.

Unlike traditional Medicare plans, Medicare Advantage is provided by private insurance companies.

Medicare Advantage provides extensive coverage for patients, but it also requires that patients abide by certain rules and guidelines outlined in the plan itself. For example, Medicare may only provide assistance if the patient visits a doctor or hospital that belongs to a Medicare-approved network. For Memphis residents, it is important to know which doctors in the Shelby county area operate in this network.

One distinct perk of Medicare Advantage is preventative health maintenance. Many Medicare Advantage plans offer health club memberships in Memphis and also provide patients with routine preventative exams, disease management programs, and transportation services to physician’s offices – services which aren’t covered under Parts A and B alone. Certain plans through Medicare Advantage also offer vision and dental coverage as well.

It is also important to remember that a patient can join Medicare Advantage even if he or she has a pre-existing condition, like diabetes, heart disease or high blood pressure.

1. Don’t assume basic Medicare will cover everything. Although Medicare Part A and B can cover up to 80 percent of medical related expenses, you will still be responsible for the remaining 20 percent. It is important to properly budget for unforeseen expenses should anything arise that standard Medicare might not pay for, including some routine lab work, chiropractic care and visits to specialists.

2. Do purchase Medicare Supplements. Since Medicare alone can’t cover all of your medical expenses, it is important to make sure you have a safety net in place for gaps in coverage, like hospitalization, ambulance services and home health care. Medicare Supplements, also known as Medigap policies, can help relieve the burden of these extra expenses by reducing a patient’s co-payments significantly or sometimes eliminating them altogether. Medigap policies are also very cost efficient for people who travel, as the patient is not restricted to only network-approved hospitals.

3. Do choose the plan that is right for you. There are multiple unique plans for Medicare, covering anything from emergency room treatment to prescription drugs to routine doctor’s visits. Make sure you know which Medicare plan is right for you before you enroll.

4. Don’t delay in signing up for coverage. All Memphis and U.S. residents of at least five years are eligible for Medicare when they turn 65. If enrollment is delayed, late penalties will be added to the prescription drug plan for the entire length of your membership.

5. Don’t forget about your current health insurance. Medicare can often work with your existing, local Memphis health insurance plans, and it is important to fully understand the areas in which you are already covered. This will make your decision as to which coverage you need much easier.

6. Do consult a Medicare agent. The coverage you initially signed up for may not be the coverage you need throughout your lifetime. That’s why it’s important to talk to a Memphis Medicare agent to make sure you are getting the right coverage. Medicare is flexible, and your plan can be changed in response to your changing health and personal needs each year during the Annual Enrollment Period from Oct 15 through Dec 7.

7. Don’t forget to review your plan each year. As mentioned in number six, it is important to regularly review your plan and to remember that the enrollment period runs during a short window of time each year. This is your chance to calculate expenses and add up any unexpected costs over the previous year, including ER visits, immunizations and prescription drug costs and decide if you need more or less coverage.