Understanding Medicare
What do I need to know?
Medicare has a lot of moving parts, but the basics get easier once you know what each part does. Medicare is the federal health insurance program primarily for people age 65 and older, though certain younger individuals with disabilities or specific conditions such as ESRD, end-stage-renal disease, or ALS (Lou Gehrig’s disease) also qualify. Medicare is operated by the Centers for Medicare and Medicaid Service (CMS) and consists of four different parts.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact medicare.gov or 1-800-MEDICARE to get information on all of your options.
Here’s the simple version.
Part AHospital Insurance
Part A helps cover inpatient hospital care, skilled nursing facility care, hospice care and some home health care. Most people don’t pay a monthly premium for Part A because they or their spouse paid Medicare taxes while working. If you don’t qualify for premium-free Part A, you may have to pay a monthly premium for it.
Part BMedical Insurance
Part B helps cover things like doctor visits, outpatient care, preventive services, lab and diagnostic testing, durable medical equipment and other medically necessary services. Most people pay a monthly premium for Part B. If you receive Social Security benefits, that premium is usually deducted automatically. If not, Medicare will generally bill you directly.
Part CMedicare Advantage
Medicare Advantage, also called Part C, is another way to receive your Medicare benefits. These Medicare health plans are offered by private insurance companies approved by Medicare and provide your Part A and Part B benefits. Most also include Part D prescription drug coverage and may offer additional benefits.
Part DPrescription Coverage
Part D helps cover prescription drugs. Coverage and costs can vary depending on the medications you take.
What is Medicare Supplement Insurance?
Original Medicare covers many healthcare services, but it doesn’t cover every cost. You’re still responsible for certain deductibles, coinsurance and other out-of-pocket expenses. Medicare Supplement Insurance, also called Medigap, is private insurance that works alongside Original Medicare and helps with some of those out-of-pocket costs. There are also important rules about when you can enroll in a Medigap policy, so timing can matter.
How Does Enrollment Work?
When you enroll in Medicare matters.
Different enrollment periods apply to different situations, and missing the right one can sometimes mean a late-enrollment penalty or a gap in coverage.
You don’t need to memorize all of them. You just need to know which one applies to you.
Initial Enrollment Period:Your first opportunity to enroll in Medicare generally lasts seven months: the three months before the month you turn 65, your birthday month, and the three months after. This is when many people first enroll in Medicare Part A and Part B and decide how they want to receive their Medicare benefits.
Annual Election Period (Oct 15 – Dec 7):This is the annual opportunity to review your Medicare Health Plan and make certain changes to your Medicare Advantage or Part D Prescription Drug Plan for the coming year.
Open Enrollment Period (Jan 1 – March 31):If you’re already enrolled in a Medicare Advantage plan, you can make one change to another Medicare Advantage plan or leave Medicare Advantage and return to Original Medicare. During this period, if you return to Original Medicare, you can join a separate Part D Prescription drug plan. This period does not allow someone with Original Medicare to simply enroll in Medicare Advantage and certain rules apply depending on your situation.
Special Enrollment Periods:Certain life events or changes in circumstances may give you an opportunity to enroll or change outside the usual enrollment periods. Examples can include losing employer coverage, moving outside a plan’s service area or other qualifying circumstances.
You don’t have to know everything about Medicare.But a few details can make a big difference.
When do I need to enroll?
What does each part actually do?
What choices do I have?
When can I make a change?
You don’t need to memorize all the rules. You just need to know what deserves your attention—and when it’s time to ask a question.