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Frequently asked questions
If you're already receiving Social Security benefits, you’ll be automatically enrolled in Medicare Part A and Part B, and your card should arrive about 3 months before your 65th birthday.
If you’re not receiving Social Security yet, you’ll need to manually enroll through Social Security (online, by phone, or in person).
• Affordable Care Act (ACA) Plans – Available during Open Enrollment (Nov. 1 – Jan. 15) or with a Special Enrollment if you lose coverage.
• Short-Term Health Insurance – A temporary plan for gaps in coverage, like between jobs or waiting for new benefits.
• Health Care Sharing Programs – A faith-based, non-traditional coverage option.
Medicaredoes not typically cover long-term care services, such as custodial care in a nursing home or assisted living facility. However, it may cover short-term skilled nursing care or rehabilitation services after a hospital stay. For long-term care coverage, individuals often consider Medicaid or private long-term care insurance policies.
You may qualify for a Special Enrollment Period if you experience certain life events, such as:
• Losing existing health coverage (e.g., job-based, individual, or student plans).
• Moving to a different ZIP code or county.
• Experiencing changes in your household (e.g., marriage, divorce, birth of a child).
• Becoming eligible for Medicaid or the Children's Health Insurance Program (CHIP).
Coinsuranceis your share of the costs of a covered healthcare service, calculated as a percentage (e.g., 20%) of the allowed amount for the service. You start paying coinsurance after you've paid your plan's deductible. For example, if your plan's allowed amount for a service is $100 and you've met your deductible, your 20% coinsurance payment would be $20.
HMO (Health Maintenance Organization): Requires members to choose a primary care physician (PCP) and obtain referrals to see specialists. Coverage is typically limited to providers within the HMO network.
PPO (Preferred Provider Organization): Offers more flexibility, allowing members to see any healthcare provider without a referral, both in-network and out-of-network, though out-of-network services may come with higher costs.
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