Overview of Medicare
What is Medicare?
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The following overview of Medicare covers the different parts of Medicare coverage and information on when you can enroll and includes a FAQ section.
Eligibility and Enrollment
Timing is important when it comes to Medicare Enrollment
To sign up for original Medicare Parts A & B, along with Part D, most people will have an Initial Enrollment Period which is a 7 month period around the time they turn age 65. This period begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.
Once your Initial Enrollment Period is over, if you wish to change or purchase Advantage or Part D Plans, you must act during the open enrollment period.
- Medicare Enrollment - October 15th - Dec 7th
What if you miss the deadline?
When open enrollment is closed, there are special circumstances in which one may qualify to enroll outside of the enrollment period. Listed below are the qualifying events:
- You are turning 65
- You move to a new area that is not in your current plan’s service area
- Recently moved back to the US
- You lose your current coverage (either Group or Medicaid)
- You now need a SNP (Special Needs Plan) or you no longer need a SNP
The Different Parts of Medicare
Medicare Part A (Hospital Insurance)
Part A is automatic and covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Most people get Part A for free.
Medicare Part B (Medical Insurance)
Part B is automatic if you do not have other coverage through an employer or spouse. Part B coverage resembles what you may think of as traditional health insurance and covers certain doctors’ services, outpatient care, medical supplies, and preventive services. Most people will pay a standard Part B premium which varies depending on income.
Medicare Advantage Plans are offered by private carriers and replace your original Medicare Parts A and B, as they are rolled into one plan. You can select between an HMO or PPO, and most plans may cover more of your healthcare costs and have additional benefits, such as prescription drug coverage. Some may have dental or vision benefits. Premiums vary based on coverage, carrier and geographical location.
Prescription drug coverage offered by private carriers contract with Medicare. Because premiums vary greatly, you should carefully weigh your prescription costs against all variables of these plans. Selecting the wrong plan can wind up costing you thousands. Some Medicare Advantage plans may offer prescription coverage as well.
Please note that you should sign up for Part D (even if you do not have prescriptions) when you first turn 65, as waiting may result in a costly monthly penalty added to your premium.
Medicare Supplement Insurance policies complement your Original Medicare Parts A and B. They cover some, if not all, of the expenses that Part A and B do not cover, like co-pays, deductibles and other charges.
There are many different types of Medicare Supplement policies available, however they are regulated so the benefits for these various policies (known as Plan A through N), are all the same regardless of the carrier. However, premiums can vary greatly among carriers.
Please visit our page with all the Medigap plans available in a convenient comparison chart.
FAQ About Medicare
No, Medicare is not automatic unless you are receiving Social Security benefits.
Your initial enrollment period starts 3 months before your 65th birthday, and includes your birthday month, and ends 3 months after your 65th birthday.
You can apply online or call your local Social Security office. You’ll enroll, create your Medicare account, track your Medicare information such as bills, claims, health information and more, as well as print your Medicare card.
To enroll, you will be required to provide proof of your eligibility. Some acceptable documents are birth certificate, proof citizenship if not born in the US, W-2 or tax forms, and or military records.
Know your needs. Make a list of your healthcare costs and needs, including regular health maintenance visits, specialists you see, prescription drug costs and any procedures you know you will need.
Check your providers. Do your current healthcare providers accept Medicare? While most do, some doctors opt out of Medicare and are not required to follow Medicare rules, which could cost you.
Ask for help. We’ll do the hard work for you, helping you to add up all your costs (copays, premiums, etc.) so you can pick the best option. Our guidance is provided at no cost and no obligation!
When you are eligible for Medicare, signing up right away helps you to avoid premium surcharges, however, if you have “credible” coverage through an employer you may not have to.
Does your employer have less than 20 employees? If so, you still will need to enroll in Medicare Parts A & B which will serve as your primary insurance, with your employer coverage as secondary. If you fail to enroll, your employer plan may not pay your medical claims.
Are you on COBRA? If so, you will need to enroll in Medicare to avoid premium surcharges.
If you are not on COBRA, and your employer has more than 20 employees, in this instance, you can stay on your employer coverage. In order to avoid premium surcharges, you have an eight-month special enrollment period to sign up for Medicare when you leave your job, or if your employer stops offering coverage. It will start the month after you separate from your employer, or the month after your group health coverage ends – whichever happens sooner.
Most people get Part A for free, which is Hospital Coverage. Most people will pay a standard Part B premium for Medical coverage which varies depending on income. Additionally, you will pay a separate premium for Part D, prescription drug coverage. See our page on Mediare Premiums for more info.
Original Medicare does not. There are copays, coinsurance, and deductibles. You may get more of your costs covered with an Advantage Plan, which may or may not have additional benefits such as vision, dental and hearing. OR, you can purchase a separate Medigap policy to fill in the gaps of your Original Medicare. For more info, visit our Medicare Premiums page or view our Medicare Options Compared chart.
Both of these Medicare options are sold by private carriers. You do, however, have to be already enrolled in Original Medicare before you can buy or switch to these options.
Once enrolled, you must act during annual open enrollment if you need to switch to Medicare Advantage or change your existing Advantage plan.
For Medicare Supplements – note you have a once in a lifetime window that begins the month you become eligible for Medicare and allows you to enroll in any Medigap plan without answering health questions, meaning you won’t be denied coverage or pay higher premiums for health problems. After this window closes, if you wish to buy a Supplement plan, you can do so at any time of the year, but you’ll most likely have to go through medical underwriting.
Prescription drug coverage is Part D of Medicare and is offered by private carriers who contract with Medicare. Even if you do not take medications routinely, you should enroll in a plan as soon as you are eligible to avoid penalty surcharges. Because premiums vary greatly, you should carefully weigh your prescription costs against all variables of these plans. Selecting the wrong plan can wind up costing you thousands. Some Medicare Advantage plans may offer prescription coverage as well.
Typically, Medicare does not cover these costs unless they are related to services received in a hospital. Medicare does however cover some eye care services for diabetics, such as testing and treatment for diabetic retinopathy, or glaucoma. It also covers other eye disease, such as age-related macular degeneration (AMD).
They only way to have most of these types of services paid for by Medicare is through a Medicare Advantage plan.
Request FREE Consultation
Shelly Winson is an insurance professional with more than 30 years of experience. She specializes in helping people with the important, and complicated milestone of Medicare. Transitioning to Medicare is a complex process that requires truly understanding your options and the best Medicare solutions for your specific situation.
Most people don’t consider that one illness can quickly wipe out a nest egg without the proper coverage. Shelly can help you avoid the most common mistakes, saving you money in fines and penalties, as well as excessive out-of-pocket costs.
- There is never a fee for our guidance
- We help you assess your needs and match you with the best Medicare and Supplemental plan options for your specific circumstances.
- We make sure your preferred doctors are in your plan.
Request FREE Consultation
Shelly Winson is an insurance professional with more than 30 years of experience. She specializes in helping people with the important, and complicated milestone of Medicare.
Transitioning to Medicare is a complex process that requires truly understanding your options and the best Medicare solutions for your specific situation.
Most people don’t consider that one illness can quickly wipe out a nest egg without the proper coverage. Shelly can help you avoid the most common mistakes, saving you money in fines and penalties, as well as excessive out-of-pocket costs.
- There is never a fee for our guidance
- We help you assess your needs and match you with the best Medicare and Supplemental plan options for your specific circumstances.
- We make sure your preferred doctors are in your plan.