1. How much will my monthly premium be?
 Your monthly premium will depend on how much coverage you wish to have.  If you only require hospitalization coverage, or Part A, you won’t be responsible for a monthly premium. Any additional coverage will require extra monthly premiums.  Your Medicare agent will work with you to determine how much extra coverage you may need based on your individual health status.

2. Am I also eligible for Medicaid?
Many current Medicare patients are not aware that they may also be eligible to receive Medicaid (or TennCare for Nashville residents) benefits as well. A Medicare agent should be able to work with you to determine if you qualify for coverage under both.

3. What if I become ill and I’m away from my family doctor/hospital?
Standard Medicare provides coverage anywhere in the United States, so you can be treated at any hospital without additional fees or penalties. Medicare Advantage and certain HMOs, however, do require for you to be treated at specific hospitals that are considered “in-network.” A Medicare agent can help you determine which plan is best for you and your lifestyle, as well as which hospitals and doctors are in the network in Nashville.
4. Which doctors and hospitals are included in my network?
 Generally, residents of large cities in Tennessee like Nashville, Memphis and Knoxville will have access to a greater variety of facilities than those who live in rural areas. It is important to discuss this with your Medicare provider before you need to seek treatment, as receiving treatment at hospitals that are out of the network can be costly.
5. Do I need to buy Medicare Supplements?
Medicare Supplements, also known as Medigap policies, serve a distinct purpose in healthcare, and that is to fill in the holes that may be present in standard Medicare coverage. Medigap can be very cost-effective for Nashville patients who travel away from their home doctor, as it allows them to see visit any hospital or doctor to receive care. It is also a good option for patients who require frequent check-ups and treatment for conditions like diabetes, arthritis and cancer.
6. Will my rates go up?
Like anything else with a price tag, Medicare costs do increase over time. It is important to plan ahead for inevitable price increases in order to properly budget your monthly expenses. Your Medicare agent can discuss this with you and alert you to any potential premium increases.
7. Do I also need to purchase dental and vision insurance?
Dental and vision care is not provided by standard Medicare. However, many Medicare Advantage programs do provide this coverage. If you require either dental or vision care, it is important to consult with your Nashville Medicare agent to find out if you should purchase separate insurance or purchase a Medicare Advantage plan that includes both.
8. Can I still get Medicare coverage if I already have health insurance?
Yes. In fact, if you are eligible for Medicare you should always apply for coverage even if you already have a private health insurance plan. Medicare will often help pay for treatments that may not be entirely covered by your current health insurance plan. A Medicare agent will help you pick the right coverage that will complement your health insurance plan.
9. How much will my prescriptions cost?
While Medicare Part B helps pay for a large percentage of prescription medications, there are still many drugs that are not included in its coverage policy. It is important to ask your Medicare agent or provider if the drugs you are currently taking are covered under Part B or if you will have to pay for them out of pocket.

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

It is easy to confuse these two terms, and while they may share many similarities, there are also some fundamental differences between the two.

Medicare is a federal government sponsored healthcare plan that is available to all Nashville residents and United States citizens 65 years or older who have been a legal resident of the country for at least five years and have worked in the U.S. for at least 10 years.

Medicare is split into four distinct plans, with each providing different amounts and aspects of coverage.

Part A, also known as hospital insurance, pays for overnight hospitalization and most other fees that may be incurred during the course of treatment. Part A often comes into play when a patient requires surgery or must be admitted to the hospital following an accident or serious illness. Part A is provided at no extra cost to anyone who is eligible for Medicare.

Part B, also known as medical insurance, is an optional form of coverage that pays for routine outpatient treatment, such as x-rays, laboratory work, immunizations and emergency care. Part B also provides coverage for medical equipment that patients might require, including wheelchairs, oxygen tanks, and prosthetics. Patients who enroll in Part B will be required to pay a separate monthly premium to receive benefits.

Part D is also known as the prescription drug plan. It was added to Medicare in 2006 and covers a wide variety of prescription drugs. It requires a separate monthly premium and is available to anyone who is covered by Parts A or B. However, like all plans it does come with certain restrictions and will only cover drugs that have been approved by the FDA. Part D also excludes some types of drugs including barbiturates, weight loss drugs, and any drug designed for cosmetic use.

Part C is known as Medicare Advantage and is a combination of Parts A and B. It also has the flexibility to allow patients to enroll in Part D as well. Medicare Advantage has a lower monthly premium than other plans, but co-payments after receiving treatment are typically higher.

On the other side of the coin, there is Medicaid.

Medicaid is also a government sponsored healthcare program that provides inpatient and outpatient services to patients, but unlike Medicare, it is also run on the state level. Residents of Nashville and people throughout Tennessee may recognize it as TennCare.

Medicaid is issued to residents of each individual state on a needs basis. If a person meets a certain criteria of income level and overall asset value, they may be eligible to receive Medicaid. Being a recipient of Medicare does not prevent a person from receiving Medicaid benefits and vice versa, and many people are eligible to receive both.

Unlike Medicare, Medicaid is very broad in its coverage of health-related expenses. Doctor and hospital visits are mostly paid for by Medicaid, leaving the patient responsible for a small co-payment. Many prescription drugs are also included in Medicaid’s coverage as well.

Many Nashville residents may worry that their Medicare premiums will increase over time. Current projections through 2014 show that while Medicare premiums are in fact expected to increase, the overall amount of the increase will be slight. A recent statistic released by the Center for Medicare and Medicaid Services shows Medicare premiums for Plan B at $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 is a right of all United States citizens in Nashville and throughout the country who meet the following three conditions: They are 65 years of age or older; they have been a resident of the United States for at least five years; and either they or their spouse has worked in the U.S. for 10 years. Certain exceptions are also made for patients with disabilities such as end-stage renal failure and kidney disease.

For patients who only require basic medical services like occasional doctor visits and prescription drugs, standard Medicare is a good option. But for patients who require more frequent or intensive treatment, regular Medicare may not be enough.

Medicare Supplements, also known as Medigap policies, are designed to fill in the gaps in coverage that may exist with standard Medicare and help ease the burden of frequent and expensive co-payments some patients are required to pay on a regular basis.

Medigap policies can be extremely helpful for patients who require regular doctor visits for conditions like diabetes, arthritis, and cancer. While standard Medicare will pay a portion of the patient’s co-payment, they are still responsible for around 20 percent of the total cost. Medicare Supplements can fill that coverage gap, giving the patient more freedom from expensive co-pays.

For Nashville residents who need the most Medicare coverage possible, there is Medicare Advantage. This plan is a combination of Medicare Part A, or hospital insurance, and Part B, or medical insurance. This provides base coverage for most hospital and doctor visits a patient may require.

Medicare Advantage is financed by private insurance companies that work alongside the federal government to provide health coverage. Due to its lower monthly premiums, it is usually less expensive than standard Medicare plans. Medicare Advantage is also flexible in that current Medicare patients can join even if they have a current, pre-existing condition like high blood pressure, diabetes and certain physical disabilities.

While Medicare Advantage may offer a more complete solution when it comes to patient treatment, it is also subject to restrictions and guidelines that a patient must follow. For example, a patient may only be allowed to see certain doctors and visit certain hospitals that are within the Medicare-approved network. Nashville and Davidson County residents should consult with their Medicare providers before receiving care to verify their treatment center is in the network.

Medicare Advantage differs from standard Medicare by also offering preventative maintenance care. Some plans feature gym and health club memberships as well as routine physical exams targeted at early detection of disease and abnormalities. Medicare Advantage members may also be eligible for disease management programs as well as transportation to hospitals and doctor’s offices. This makes Medicare Advantage a good option for residents of rural areas around Nashville and throughout Davidson County.

1. Do your homework before choosing a plan. Medicare offers several different plans, and while one person may only need prescription drug coverage, another may need routine doctor visits and frequent blood tests. It is important to make sure you are familiar with what each plan offers and how it can benefit you before you enroll.

2. Don’t assume standard Medicare will pay for everything. Medicare Part A and B can offset a large amount of health related expenses (up to 80%), but they are not designed to fully cover all of the treatments you may require. Depending on your level of coverage, you may need to budget for the remaining 20 percent of costs, which can include things like emergency room visits and prescription drug costs.

3. Do consider purchasing Medicare Supplements. If you know you need extra coverage beyond standard Medicare, it is a good idea to look into Medicare Supplements. These can act as a safety net for large gaps in coverage such as medications and visits to specialists that might be present under standard Medicare. For example, Medicare Supplements can greatly reduce or even eliminate your responsibility for co-payments after a routine doctor visit.

4. Don’t procrastinate when signing up for Medicare. If you are a United States citizen 65 years or older who has worked for at least 10 years, you are eligible for all forms of Medicare. If you delay your enrollment for Part B, however, you could be charged a late penalty which will be in effect throughout the entire time you have the plan.

5. Don’t forget to review your health and your plan each year with a Medicare agent. Medicare is flexible, and it is possible to change your plan during the Annual Enrollment Period each year. Because of this, it is important to stay up to date on your own health and the various treatments you may require. Adding coverage for outpatient services like blood tests and physical exams can go a long way to reducing your medical bills.

6. Do see if you qualify for Medicaid. For Nashville and other Tennessee residents, Medicaid is also known as TennCare, and is similar to Medicare except it is more inclusive and is provided free of charge to patients who are on a limited monthly income. It is possible for a patient to receive both Medicare and TennCare at the same time.