Medicare Part A & B

With more than 60 million Medicare enrollees in the country, if you’re an adult in the U.S. chances are that you either receive Medicare benefits or know someone who does. If you or a loved one will soon be eligible Some health plans require you to meet minimum requirements before you can enroll. for Medicare, and have questions, we have answers.

Medicare: The Basics

Medicare is public health insurance for adults who:

• Are 65 years of age or older.
• Are younger than 65 years of age but have qualifying disabilities A disability is a restriction or lack of ability (resulting from an impairment) to perform an activity in the manner or within the range considered normal for a human being. The Social Security Administration judges disability — and whether you qualify for financial assistance — based on whether you can work. .
• Are U.S. citizens or permanent residents.

Administered by the Centers for Medicare & Medicaid Services (CMS), Medicare receives funding through the federal budget, income taxes paid to Social Security and Medicare, and premiums paid by Medicare beneficiaries. Original Medicare (Part A and Part B) insurance can be used at any doctor’s office or hospital in the U.S. that accepts it.

Medicare Part A and Medicare Part B cover most standard healthcare services. Part A is hospital insurance, covering inpatient care you receive in hospitals and other facilities. Part B is medical insurance, which covers doctor’s office visits and other outpatient care.

Between Parts A and B, Original Medicare helps pay for a wide range of essential services. To pay the costs Original Medicare doesn’t cover, you may consider adding a Medicare Supplement Insurance (Medigap) plan from a private insurance carrier. You also have the option to switch to a privately administered Medicare Advantage plan, which substitutes for Original Medicare and may include additional benefits.

Medicare can help you save on healthcare costs, but it isn’t free. Here are some of the expenses you should consider as you plan your budget:

How do you enroll in Original Medicare? Most Americans are automatically enrolled in Part A when they reach 65 years of age.

You must contact the Social Security Administration to enroll in Part B if you’re already enrolled in Part A. You can enroll online if you actively sign up for both Parts A and B at the same time.

Because you pay a premium for Part B coverage, you can turn down the coverage. If you turn down Part B coverage during your Initial Enrollment Period but choose to join later, you may be charged a late enrollment penalty and have to pay a higher monthly premium.

To cover the costs of most medications, you will need a Medicare Part D prescription drug plan:

• Part D is an optional Medicare benefit that helps you pay for any prescription medications you currently use or will need in the future.
• Private health insurance companies administer Part D. The federal government sets specific requirements, but private health insurance companies set costs and decide which drugs to cover.

You can either add a Part D plan to your Original Medicare coverage or choose to enroll in a Medicare Advantage prescription drug (MAPD) plan.

The majority of Americans enroll in Medicare health insurance around the time they turn 65 years old. Remember the seven-month rule, which says that you have seven months to enroll in Medicare during the year you turn 65.

For example, if you turn 65 in August:

• Three months before your birth month: May, June, July
• Your birth month: August
• Three months after your birth month: September, October, November

You’re eligible for Medicare if you’re an American citizen or a resident who has lived in the U.S. legally for five or more years, and if any of the following apply to you:

• You’re 65 years of age or older.
• You’ve received Social Security disability benefits for more than 24 consecutive months.
• You’ve received disability benefits from the Railroad Retirement Board for more than 24 consecutive months.
• You have kidney failure, also known as end-stage renal disease, requiring permanent dialysis or need a kidney transplant.
• You’re living with Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease.

Here’s a recap of Original Medicare, its costs, how to enroll, and what it covers:

• Original Medicare includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance).
• If you want prescription drug coverage, you can join a separate Part D plan from a private health insurance carrier.
• To help pay your out-of-pocket costs in Original Medicare (like 20% coinsurance), you can also explore Medicare Supplement coverage.
• You can use any doctor or hospital that accepts Medicare, anywhere in the U.S.

Original Medicare is one way to get Medicare. Another option is Medicare Advantage. We recommend you also take time to learn about both Medicare Advantage and Medigap, comparing what you can expect to pay in premiums and out-of-pocket costs. These are all important pieces of making the best decision for your care.

You can always contact a GoHealth licensed insurance agent to get answers. GoHealth works for you, not insurance companies, and will take time to discuss all your options.