What's Medicare?

Overview

Medicare is a health insurance program for people aged 65 and older, certain younger people with disabilities, and people with end-stage renal disease. It is a federal program that is administered by the Centers for Medicare and Medicaid Services (CMS).

Medicare has four parts: Part A, Part B, Part C, and Part D.

Part A covers hospital stays, skilled nursing facility care, hospice care, and some home health care.
Part B covers doctor's services, outpatient care, medical supplies, and preventive services.
Part C is a type of Medicare Advantage plan that combines Parts A and B, and may also include prescription drug coverage.
Part D is prescription drug coverage.

Medicare is a vital program that helps millions of Americans access the healthcare they need. However, it is important to understand that Medicare does not cover all healthcare costs. There are many out-of-pocket costs associated with Medicare, such as deductibles, coinsurance, and copayments.

Medicare beneficiaries can also purchase supplemental insurance, such as Medigap or a Medicare Advantage plan, to help cover some of these out-of-pocket costs.

If you are eligible for Medicare, it is important to enroll as soon as possible. You can enroll during your Initial Enrollment Period, which begins three months before your 65th birthday and ends three months after your birthday. If you miss your Initial Enrollment Period, you may have to pay a late enrollment penalty.

You can also enroll in Medicare during a Special Enrollment Period if you have certain life events, such as losing your job-based health insurance.

To learn more about Medicare, visit the Medicare website at www.medicare.gov.

Medicare Part A

Medicare Part A is a hospital insurance program that helps cover inpatient care in hospitals, skilled nursing facilities (not custodial or long-term care), hospice care, and some home health care.

Part A is one of the four parts of Medicare, along with Parts B, C, and D. Part A is usually free for people who have worked and paid Medicare taxes for at least 10 years. However, if you didn't work long enough to qualify for free Part A, you may be able to buy it.

Here are some of the things that Part A covers:

Inpatient care in a hospital
Skilled nursing facility care
Hospice care
Home health care

Part A also covers some other things, like blood transfusions, and some preventive care, like mammograms and Pap tests.

There are some things that Part A doesn't cover, like prescription drugs, dental care, and vision care. You can get coverage for these things with a Medicare Part D prescription drug plan, a Medigap supplemental insurance policy, or a Medicare Advantage plan.

Medicare Part B

Medicare Part B is a medical insurance program that helps cover doctor's services, outpatient care, medical supplies, and preventive services. It is one of the four parts of Medicare, along with Parts A, C, and D.

Part B is usually paid for by monthly premiums, which are deducted from your Social Security check. You may also have to pay a copayment or coinsurance for some services.

Here are some of the things that Part B covers:

Doctor's services

Outpatient care

Medical supplies

Preventive services

Part B also covers some other things, like ambulance services and some durable medical equipment.

There are some things that Part B doesn't cover, like prescription drugs, dental care, and vision care. You can get coverage for these things with a Medicare Part D prescription drug plan, a Medigap supplemental insurance policy, or a Medicare Advantage plan.

Medicare Part C

Medicare Part C, also known as Medicare Advantage, is a type of Medicare health plan that combines all of your Original Medicare benefits (Part A and Part B), and often includes prescription drug coverage (Part D). Medicare Advantage plans are offered by private companies.

Medicare Advantage plans typically have lower out-of-pocket costs than Original Medicare, including lower deductibles, copayments, and coinsurance. They may also offer additional benefits, such as dental, vision, and hearing coverage.

To be eligible for Medicare Advantage, you must first be enrolled in Original Medicare. You can enroll in a Medicare Advantage plan during your Initial Enrollment Period, which begins three months before your 65th birthday and ends three months after your birthday. You can also enroll in a Medicare Advantage plan during a Special Enrollment Period if you have certain life events, such as losing your job-based health insurance.

There’s also a maximum out-of-pocket limit for Part C plans which, in result, reduces the total out-of-pocket costs you’ll need to cover. In case you have a Medicare Advantage program you must pay for your Part B deductible. Some Advantage plans might partly cover for the deductible but you would need to check with your provider.

If you are considering enrolling in a Medicare Advantage plan, it is important to compare plans carefully to find one that best meets your needs.

Medicare Part D

Medicare Part D is a prescription drug plan that helps cover the cost of prescription drugs.

Part D is voluntary, but it is important to have prescription drug coverage if you take prescription drugs. If you don't have Part D coverage, you may have to pay full price for your prescription drugs.

You can enroll in a Medicare Part D plan during your Initial Enrollment Period, which begins three months before your 65th birthday and ends three months after your birthday. You can also enroll in a Medicare Part D plan during a Special Enrollment Period if you have certain life events, such as losing your job-based health insurance.

When you enroll in a Medicare Part D plan, you will choose a formulary, which is a list of covered drugs. Each formulary has different tiers, which determine how much you will pay for each drug.

Here are some of the things to consider when choosing a Part D plan:

The cost of the plan
The drugs that are covered by the plan
The plan's formulary, or list of covered drugs
The plan's copayment or coinsurance amounts
The plan's deductible

It is important to compare plans carefully to find one that best meets your needs.

Medicare Supplement

A Medicare Supplement, also known as Medigap, is a type of private health insurance that helps pay some of the costs of Original Medicare that Original Medicare doesn't cover, like copayments, coinsurance, and deductibles.

Medigap policies are standardized, which means that they all cover the same basic benefits. However, there are 10 different Medigap plans (A, B, C, D, F, G, K, L, M, and N) each with its own set of benefits and costs.

Medigap plans are available to people who have Medicare Part A and Part B. You can buy a Medigap plan any time you have Medicare Part A and Part B, but you may have to pay a higher premium if you wait too long.

Even though Medicare Supplement plans all have standardized benefits, each Supplement plan’s cost is based on the insurance company you choose and other factors so there is no fixed answer concerning the costs of these plans. Insurance providers usually offer discounts on Medicare Supplement plans due to certain reasons such as discounts for non-smokers, women, or people who pay their premiums in advance each year.

Medigap plans can be a good way to lower your out-of-pocket costs for Medicare. However, it is important to compare plans carefully to find one that best meets your needs. You can compare plans on the Medicare website or with a licensed insurance agent or broker.

Here are some of the things to consider when choosing a Medigap plan:

The cost of the plan
The benefits that are covered by the plan
The plan's network of doctors and hospitals
The plan's rules and regulations

It is important to note that Medigap plans do not cover all of the costs of Medicare. You will still have to pay some out-of-pocket costs, such as copayments and coinsurance.

Am I Eligible?

Eligibility Requirements:

Age 65 or older
Disabled
End-Stage Renal Disease (ESRD)

Part B is a voluntary program that requires the payment of a monthly premium for all months of coverage.

The eligibility rules for Part B depend on whether a person is eligible for premium-free Part A or whether the individual has to pay a premium for Part A coverage. Individuals who are eligible for premium-free Part A are also eligible for enrollment in Part B once they are entitled to Part A.

Individuals who must pay a premium for Part A must meet the following requirements to enroll in Part B:

Be age 65 or older;
Be a U.S. resident; AND
Be either a U.S. citizen, OR
Be an individual who has been lawfully admitted for permanent residence and has been residing in the United States for 5 continuous years prior to the month of filing an application for Medicare.

Medicare Enrollment

You can join, switch, or drop a Medicare Health Plan, with or without drug coverage, during these times:

Initial Enrollment Period

When you first become eligible for Medicare around the age of 65, you can join a plan.

Open Enrollment Period.

From October 15 – December 7 each year, you can join, switch, or drop a plan. Your coverage will begin on January 1 (as long as the plan gets your request by December 7).

Medicare Advantage Open Enrollment Period

From January 1st – March 31st each year, if you’re enrolled in a Medicare Advantage Plan, you can switch to a different Medicare Advantage Plan or switch back to Original Medicare (and join a separate Medicare drug plan) once during this time.

Most people enroll in Part A and Part B at the same time. You are eligible to enroll in the Initial Enrollment period which begins 3 months before your 65th birthday and ends three months after your 65th birthday. Also, you have to be a U.S. citizen or have a permanent residence for a minimum of five years to be eligible for Original Medicare. If you don’t enroll during the Initial Time Period you may have to pay the late enrollment penalty.

However, if you have Social Security benefits already you’ll be enrolled in Part B automatically, but if you don’t, you’ll need to do it by yourself.