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Medicare & You

For Those Getting Started with Medicare

Know Your Options to Join and Evaluate Medicare

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Understanding Medicare: The Basics

Medicare is a federal health insurance program created in 1965 for people 65 years of age or older, and individuals with disabilities. Today, Medicare provides health benefits to over 60 million people, regardless of their income, medical history, or current health. The program has several parts that help beneficiaries pay for services, including hospitals, medical treatment, preventive care, prescription drugs, and more.

Medicare beneficiaries can choose to have Original Medicare (Parts A & B) or apply for additional benefits through private health insurance companies. These plans include Medicare Advantage, Medicare Supplement, and stand alone prescription drug plans. When enrolling in a private health plan, you can either enroll directly with the carrier of your choice or with a CMS-appointed health insurance marketplace like GoHealth, where our licensed insurance agents can recommend a plan that is right for you.

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What Are My Options When It Comes To Medicare?

If you’re new to Medicare, there’s a lot to consider when evaluating your options. For some, you can get Medicare Part A & B automatically, but others will need to sign up through Social Security or SSA.gov. While Original Medicare (Part A and Part B) covers your hospital and medical services, covering all your needs may require a few more decisions:

  • You may need a Medicare Part D plan for prescription drug coverage. Enrollment options include: Medicare.gov, directly from a private insurance company, or a CMS-appointed health insurance marketplace like GoHealth.
  • A Medicare Supplement plan (Medigap) will help cover the remaining 20% of what Original Medicare does not cover. Enrollment options include: Directly from a private insurance company or a CMS-appointed health insurance marketplace like GoHealth.
  • Medicare Advantage is another option that includes Original Medicare (Part A and Part B) and may include Part D, vision, and dental all in one plan. Enrollment options include: Medicare.gov, directly from a private insurance company, or a CMS-appointed health insurance marketplace like GoHealth.

We’ll dive deeper into the details of Medicare plans and coverage to help you better understand your options.

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When Would I Be Eligible for Medicare?

Most people 65 years of age or older are eligible for Medicare. If you or your spouse are eligible for Social Security payments, you can be automatically enrolled for part of Medicare when you turn 65. For individuals under 65 who receive Social Security Disability Insurance (SSDI) payments, eligibility after a two-year waiting period is common. Anyone with a diagnosis of end-stage renal disease (ESRD) and amyotrophic lateral sclerosis (ALS) become eligible without a waiting period.

Original Medicare

Original Medicare has two parts (Part A and Part B) that work together to cover 80% of your hospital and medical insurance. Original Medicare allows you to use any doctor or hospital that accepts Medicare assignment. Original Medicare covers many services and some medical supplies, but it doesn’t cover all your expenses. If you paid Medicare Taxes for 40 quarters or more you will be eligible for what is called “premium-free” Part A. Part B coverage has a monthly premium.

Original Medicare

Medicare Advantage

Medicare Advantage plans (Part C) provide all your Part A and Part B coverage, and most plans also include Part D, vision, and dental benefits. Medicare Advantage plans are provided by private insurance carriers but follow Medicare guidelines. Medicare Advantage is your alternative option to Original Medicare. Part C could also lower out of pocket costs for beneficiaries.

Medicare Advantage

Medicare Part D

Medicare Part D is an optional, stand-alone coverage that can be added to Medicare plans for your medication needs. Part D has a late enrollment penalty if you do not enroll initially once you are eligible. You pay a monthly premium for prescription drug coverage provided by a private carrier. Original Medicare and Medicare Supplement plans do not include Part D coverage. However, most Medicare Advantage plans have Part D coverage included.

Medicare Part D

Medicare Supplement (Medigap)

Original Medicare pays for much, but not all of the cost for health care services and supplies. Medicare Supplement Insurance (Medigap) policies, sold by private insurance companies, are designed to help cover remaining health care costs, like co-payments, co-insurance, deductibles not covered by Part A and Part B.

Medicare Supplement (Medigap)

Medicare & Medicaid (Plus, Low Income Subsidy)

If you qualify for Medicaid and become eligible for Medicare, you may qualify for help with your Medicare costs. Some individuals can receive dual-eligibility, which provides Medicare benefits and includes additional Medicaid coverage to cover costs not covered by Medicare. Your Medicaid works with your Medicare to limit your out of pocket cost for most benefits in your Medicare Advantage Plan. Some individuals may qualify for Low Income Subsidy (LIS) which helps lower the costs of your prescription drug coverage.

How GoHealth works

1

Join the GoHealth Family

Provide us your contact info, or give us a call, so we can connect. We want to take care of you so well, we earn the right to become "your guy or girl" in the health insurance world for years to come.

2

Let us take care of you

Health insurance is complicated - we make it simple by offering unbiased advice from any one of our licensed insurance agents. After understanding your needs, we'll walk you through your options (the pros and cons) and get you enrolled in a plan with the right coverage.

3

And, we'll keep taking care of you

A GoHealth agent is there for you, whenever you need. If you have a question about your plan (even about a claim), we're here to help. You are part of the GoHealth Family, and we'll provide you lifetime support.

Have a question?

Speak with a licensed insurance agent.

1-855-792-0088 TTY: 711

Monday - Friday, 7 AM - 8 PM CT

This website is operated by GoHealth, LLC., a licensed health insurance company. The website and its contents are for informational and educational purposes; helping people understand Medicare in a simple way. The purpose of this website is the solicitation of insurance. Contact will be made by a licensed insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. Our mission is to help every American get better health insurance and save money.

If you’re looking for the government’s Medicare site, please navigate to www.medicare.gov.