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Medicare 101

Understanding Medicare is empowering and it can help you make choices that are right for you. Whether you’re looking at plans for the first time, finding information for a loved one or already on Medicare, we’re here to help guide you.

What is Medicare?

Medicare is the federal government’s health care program. It’s offered to U.S. citizens and legal residents age 65 and older, and younger people with certain disabilities.

Learn more about the basics of Medicare

Eligibility

Learn when you may become eligible to receive Medicare benefits and what to do next.
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Enrollment

You need to enroll in Medicare yourself if you aren’t receiving Social Security benefits when you become eligible.
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Parts

Medicare is broken down into parts. And you’ll need to understand them before you can choose which ones you plan to take.
Learn More

Costs

Medicare isn’t free. The amount you’ll pay depends on the coverage you choose
Learn More

Additional Coverage

Many people choose additional coverage by enrolling in one or more private Medicare or Medicare-related plans.
Learn More

Medicare Quick Tips

  1. Original Medicare (Parts A & B).
     Part A is hospital coverage and Part B is medical coverage. Original Medicare is provided by the federal government. Benefits and coverage are the same across the country. With Original Medicare, you can also add a standalone Part D prescription drug plan and /or a Medicare supplement insurance plan.
  2. Medicare Advantage (Part C)
     These plans combine your Part A and Part B coverage, and many also include Part D prescription drug coverage and other benefits such as hearing, vision, dental or fitness. Plans are offered by private insurance companies.
  1. You may add a stand-alone prescription drug plan (Part D) to Original Medicare.
  2. Or you may enroll in a Medicare Advantage plan that includes prescription drug coverage.

Original Medicare (Parts A & B) doesn’t cover everything that you may need for your health. It doesn’t include prescription drug coverage, hearing health, dental, vision, wellness services or financial protection. If you want additional coverage, explore plans provided by private insurance companies.

Medicare Advantage plans and prescription drug plans vary in terms of coverage and cost. Insurance companies may offer several plans where you live. Medicare supplement insurance (Medigap) plans are standardized and are the same nationwide, except in Minnesota, Wisconsin, and Massachusetts.

  • Medicare Advantage plans put a cap on your out-of-pocket costs for Part A and Part B services covered by the plan. It’s called the “annual out-of-pocket maximum” and it provides built-in financial protection. There is no out-of-pocket cap with Original Medicare. Total out-of-pocket costs and financial protections may vary for in-network vs out-of-network cost.
  • Medicare supplement insurance plans help pay some out-of-pocket costs not paid by Original Medicare, like deductibles and coinsurance A variety of plans are available that offer different levels of financial protection. Medigap plans are organized by letter, such as “Plan A” or “Plan G.”
  • Both Medicare Advantage and Medicare supplement insurance plans are offered by private insurance companies. You can have either a Medicare Advantage or Medicare supplement insurance plan, but not both together.
  • Your Initial Enrollment Period (IEP) is your first chance to enroll in Medicare. It is 7 months long- it includes your birthday month or the 25th month of getting disability benefits plus the 3 months before and 3 months after.
  • You may qualify to delay Medicare enrollment if you have creditable coverage through your employer or your spouse’s employer coverage or leave your job, whichever occurs first.
  • If you enroll after your Initial Enrollment Period or Special Enrollment Period, you could face late penalties for Medicare Part A, Part B or Part D.
  • Medicare offers a General Enrollment Period ( GEP) every year January 1- March 31st for those who have missed their Initial Enrollment Period.
  • Medicare provides Special Enrollment Periods (SEP) for qualifying life events. Examples include moving your primary residence or leaving an employer health plan. Visit Medicare.gov for a complete list of qualifying events.
  • The Medicare Advantage Open Enrollment Period ( MAOEP ) is January- Marth 31st each year. You may switch to a different Medicare Advantage plan or drop a plan and go back to Original Medicare at this time.
  • The Medicare Annual Enrollment Period (AEP) happens every year from October 15th to December 7th. You may change your coverage during this time if you decide to.

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Eligibility

It's important to know what to do when you're eligible for Medicare. But who's eligible for Medicare and when? Learn when you may become eligible to receive Medicare benefits and what to do next.

You may become eligible to receive Medicare benefits based on any one of the following.

  • You are age 65 or older.
  • You are younger than 65 with a qualifying disability. Medicare eligibility begins after 24 months of receiving Social Security disability benefits.
  • Any age with a diagnosis of End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS, also called Lou Gehrig’s Disease)
  • Legal residents must live in the U.S. for at least five years in a row, including the five years just before applying for Medicare.

Medicare Enrollment

You should be automatically enrolled in Medicare Part A and Part B if you are receiving Social Security or Railroad Retirement Board benefits when you become eligible. You’ll receive your Medicare card in the mail.

You need to enroll in Medicare yourself if you aren’t receiving Social Security benefits when you become eligible. Go to SSA.gov/Medicare to enroll online, call or visit your local Social Security office, or contact us and we can assist as well.

Here’s an overview of the different times you can enroll

Around your 65th birthday you’ll have a 7-month window of time when you can sign up for Medicare. It’s called your Initial Enrollment Period – or IEP for short. Your IEP includes your 65th birthday month, the 3 months before and the 3 months after.

Eligible due to a disability?

Your 7-month IEP includes the month you receive your 25th disability check, the 3 months before and 3 months after.

Sign up early. Coverage begins the first day of your 65th birthday month if your enrollment is completed during the first three months of your IEP. It begins the month before if your birthday is on the first of the month. Your coverage start date may be delayed if you sign up later.

You can enroll in Medicare Part A, Part B or both. The GEP happens every year from January 1st to March 31st , with coverage beginning July 1st. You may enroll in a Medicare Advantage plan (Part C) or a prescription drug plan ( Part D) from April 1st to June 30th the same year.

 

Medicare also provides a Special Enrollment Period (SEP) for qualifying life events.
You have 2 full months after the month of a qualifying event to make plan changes. During this time, you may join, change or drop a Medicare Advantage or Part D prescription drug plan outside of the Medicare Annual Enrollment Period without penalty.

Common events that may qualify include:
Moving out of your current plans service area
Leaving retiree, union or COBRA coverage
Your eligible for both Medicare and Medicaid
You qualify for Extra Help paying for your Medicare Prescription Drug coverage
You qualify for a Medicare Chronic Care Special Needs Plan in your area

You still have and Initial Enrollment Period- You have Medicare decisions to make at age 65 even if you have coverage through an employer plan. (yours or your working spouse’s) Your IEP happens when you turn 65 whether you continue to work or not. Depending on the employer coverage you have, you may be able to delay enrolling in Medicare without penalty.
Talk with your employer’s benefits administrator to understand your options and to determine if your coverage is considered “creditable”.

Parts of Medicare

Medicare Part A + Medicare Part B = Original Medicare

Medicare is broken down into parts.

And you’ll need to understand them before you can choose which ones you plan to take. Let’s explore the different parts of Medicare and learn how you can use them to meet your health goals.

Medicare Part A

Hospital Coverage
What Medicare Part A covers:
  • A semi-private room
  • Your hospital meals
  • Skilled nursing services
  • Care in special units, such as intensive care
  • Drugs, medical supplies and medical equipment used during an inpatient stay
  • Lab tests, X-rays and medical equipment as an inpatient
  • Operating room and recovery room services
  • Some blood transfusions in a hospital or skilled nursing facility
  • Inpatient or outpatient rehabilitation services after a qualified inpatient stay
  • Part-time, skilled care for the homebound after a qualified inpatient stay
  • Hospice care for the terminally ill, including medications to manage symptoms and control pain
Part A covers expenses associated with hospital care. It includes coverage for services like nursing care and hospital stays. It also covers some hospital-related care that takes place outside a hospital setting. For example, skilled nursing care after you leave the hospital.

Medicare Part B

Covering your doctor visits and beyond
What Medicare Part B covers:
  • Doctor visits, including in the hospital
  • Annual Wellness Visit
  • Ambulatory surgery center services
  • Ambulance and emergency room services
  • Skilled nursing services
  • Preventive services, like flu shots or mammograms
  • Clinical laboratory services, like blood and urine tests
  • X-rays, MRIs, CT scans, EKGs and some other diagnostic tests
  • Some health programs, like smoking cessation, obesity counseling and cardiac rehab
  • Physical therapy, occupational therapy and speech-language pathology services
  • Diabetes screenings, diabetes education and certain diabetes supplies
  • Mental health care
  • Durable medical equipment for use at home, like wheelchairs and walkers
Part B complements your Part A coverage to provide coverage both in and out of the hospital. In fact, Part A and Part B were the first parts of Medicare created by the government. This is why the two parts together are often referred to as “Original Medicare.” Additionally, most people who do not have additional coverage through a group plan (such as those offered by employers) generally sign up for Parts A and B at the same time.

Medicare Costs

Medicare isn't free.

The amount you’ll pay depends on the coverage you choose, the health care services and benefits you use during the year, and if your plan has rules about network vs out-of-network costs.

What Medicare Part A costs:

You generally won’t have to pay a monthly premium for Medicare Part A if you or your spouse paid Medicare payroll taxes for 40 quarters or more. But you do need to pay deductibles before Medicare will cover any hospitalization costs.

What Medicare Part B costs:

Most people need to pay a monthly premium to maintain their Part B coverage. You also need to pay a deductible before Part B begins paying for services. And if your income exceeds a certain amount, you pay the premium plus an extra charge. This is called an Income Related Monthly Adjustment Amount (IRMAA).

Additional Coverage

You can stay with Original Medicare or get more coverage

Original Medicare (Parts A & B) doesn’t cover everything you may need for your health. It doesn’t include prescription drug coverage, hearing health, dental, vision, wellness services or financial protection. Many people choose additional coverage by enrolling in one or more private Medicare or Medicare-related plans.

Medicare Advantage Plans
(Part C)

Medicare Advantage plans combine Part A, Part B and often prescription drug coverage. Some plans may offer additional benefits like coverage for vision, dental, hearing and transportation to approved medical facilities.

Medicare Supplement
Insurance plans

Medicare Supplement Insurance plans ( Medigap) help pay some of the out-of-pocket costs of Original Medicare.

Prescription drug
plans (Part D)

Medicare prescription drug plans help pay for medications prescribed by a doctor or other health care professional.