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New to Medicare Guide

A Simple Guide to Help You Take Control of Your Health Insurance

Medicare can be tricky, but we’re here to help you make sense of everything and get ready to enroll.

What is Medicare?

Medicare is a federal health insurance program for people 65 or older and younger people with certain disabilities.

Medicare includes four parts (Parts A, B, C, D) but Original Medicare is Part A and Part B.

PART A covers inpatient hospital care, hospice care, inpatient care in a skilled nursing facility, and home health care services.

PART B covers medical care and services provided by doctors and other medical practitioners.

The Basics

There’s a lot to learn about Medicare, so let’s start with the basics.

Enrollment

Know your enrollment dates. If you are late, it could cost you.

After Enrollment

Watch for your enrollment packet in the mail.

Coverage & Benefits

When you understand how Part A and Part B coverage work, you can take steps toward selecting benefits and the health coverage you need. Original Medicare provides affordable insurance but frankly does not cover all of your costs and has minimal coverage and benefits.

  • To improve your healthcare coverage and safeguard your personal finances, you should add a Part D plan (for prescription drug coverage) and a Medigap plan (to minimize healthcare costs that Original Medicare alone leaves you susceptible to).
  • You also have the option to enroll in a Medicare Advantage (Part C) plan, which not only includes Parts A and B but in most cases additional benefits like dental, vision, hearing, prescription drug coverage, and more. Most Medicare Advantage plans are offered at no cost to you too.

Learn more about the parts of Medicare, and Medicaid.

Original Medicare (Part A, Part B)

Original Medicare covers 80% of hospital visits and medical care through Part A and Part B. It has minimal prescription drug coverage, which is why many people will add a Part D prescription drug plan as additional coverage. It may seem odd, but Part D is a stand-alone plan that you must elect to get proper prescription drug coverage.

The same is true for dental, hearing or vision plans, which aren’t covered by Original Medicare (Part A and B). If you would rather bundle all these services into one plan, consider Medicare Advantage.

Whether you’re new to Medicare, or in need of adjusting your coverage later down the line, give yourself enough time to compare your options. The wrong coverage or missing an enrollment deadline could end up costing you more you think.

Pro Tip: If you delay Part B enrollment when first eligible, you may be responsible for a lifetime late enrollment penalty once you enroll later.

Medicare Advantage (Part C)

Every Medicare Advantage (MA) plan includes the same Part A and Part B benefits that Original Medicare provides. In addition, most Medicare Advantage plans also include Part D prescription drug coverage, and many will cover additional benefits like dental, hearing, vision, etc. The important distinction is this:

  • You must be enrolled in Part A and Part B before you can enroll in Medicare Advantage.
  • Medicare Advantage plans are administered by private insurance companies. This means private insurance carriers are paid to manage Part A and Part B on behalf of Medicare and have the ability to provide added coverage like Part D, dental, hearing, or vision under a single plan.

While the Part A and Part B benefits are equal coverage to Original Medicare, any covered health benefits are limited to a local, provider network.

Prescription Drug Plan (Part D)

Medicare Part D is a stand-alone prescription drug coverage plan. Part D is only available through private insurance carriers as optional coverage to expand Original Medicare (Part A and Part B). There is a distinction between adding Part D to Original Medicare and having Part D coverage included within a Medicare Advantage plan:

  • If you add a Part D plan to Original Medicare, you will be responsible for the premiums and deductibles of that plan. Though, there are federal assistance programs that help with costs for people that qualify.
  • Medicare Advantage plans typically include Part D drug coverage. This can be a cost saver as long as you know your pharmacy and doctor are in-network and the drug is part of the plan’s formulary (a plan’s list of covered drugs).

Pro Tip: If you delay enrollment when first eligible, you may be responsible for a lifetime late enrollment penalty once you enroll later.

Medicare Supplement Plan (Medigap)

A Medigap plan is an insurance to supplement -- or cover gaps -- services not covered by Original Medicare. When you think about your different options, it’s important to know that a Medigap policy can help pay the remaining costs (which is the remaining 20%) not covered by Medicare, e.g., copays, coinsurance, and deductibles.

Like other options that can be added to Part A and Part B, you will be responsible to choose and purchase your Medigap policy, which is administered by private health insurance carriers.

Medicaid (Low Income)

People new to Medicare often confuse Medicare with Medicaid. Medicaid provides free or low-cost health coverage to children, families, pregnant women, the elderly, and people with disabilities. It’s important to know that Medicaid is a dual program run by federal and state resources, but the benefits and/or expansion of Medicaid is at the sole discretion of each state.

Can you have both Medicare and Medicaid at the same time?

Yes. You can be eligible for both Medicare and Medicaid at the same time; it’s called dual-eligibility. In these certain circumstances, Medicare will be the primary insurance and pay first for any costs and services covered under the Medicare plan. For any coverage not covered by Medicare, Medicaid will be the secondary payer and cover those costs.

Enrolling in Medicare for the First Time

Ilustration of running girl with paper

Did you know you have seven months surrounding your 65 birthday month to enroll?

Yes. It’s called your Initial Enrollment Period. For many, it’s the month of your 65 birthday, the three months before, and the three months after your birthday month. For those born on the first of the month, it’s the month of your 65 birthday, the four months before, and the two months after your birthday month.

Life happens. We know and so does Medicare. If you miss your opportunity to enroll during your Initial Enrollment Period, a General Enrollment Period from January 1 to March 31 allows enrollment and coverage will start July 1.

Pro Tip: You have a lot of time to compare and research Medicare plans the first time you enroll. Take advantage of the time to ask questions and think about what type of coverage you’ll need.

Eligibility & Enrollment

When Can I First Enroll in Medicare?

Most people are eligible
for Medicare when they turn 65.

Discover when your Medicare
Initial Enrollment Period is.

Please enter a valid date for the Date of Birth.

Your 65th Birthday is in July 2021!

Your Medicare Initial Enrollment Period is open between April 1, 2021 and October 31, 2021.

You are 97 days away from enrollment.

Life is busy. Set a calendar reminder so you won’t forget:

57% of those nearing eligibility are overwhelmed to find the right plan.


So we made it easier for you to understand how Medicare works and where to start.

Congratulations
Your Medicare Initial Enrollment Period is Now Open!

You can enroll between December 1, 2020, and June 30, 2021.

Contact a GoHealth Licensed Insurance Agent

1-855-792-0088 TTY: 711

Our goal is enroll you in a plan that is right for you, lowers your costs, and gives your the most benefits (like prescriptions, vision, hearing and/or dental) that you are entitled to.

Your Medicare Initial Enrollment Period is Closed.

Most people have seven months to first enroll in Medicare. Your initial enrollment period was between January 1, 2020 and July 31, 2020.

About:
initial enrollment period How to first enroll in Medicare outside of your Initial Enrollment: General & Special enrollment periods
Additional Enrollment (for those that have Medicare): Annual enrollment period
Don't worry! We can check if you qualify for Medicare enrollment, even if your Initial Enrollment Period has passed.
Contact a GoHealth licensed insurance agent for next steps.

We'll answer your Medicare questions and explain your options. Our goal is enroll you in a plan that is right for you, lowers your costs, and gives your the most benefits (like prescriptions, vision, hearing and/or dental) that you are entitled to.

1-855-792-0088 TTY: 711

New to Medicare Articles

The Basics

We know you feel overwhelmed. Don’t be. We created these articles to help you get started with Medicare.

basic facts & faqs medicare plans: pros & cons hmo vs. ppo pro tips medicare myths

Enrollment

How to enroll in Medicare for the first time, and how to avoid the mistakes we hear all the time.

eligibility & enrollment enrollment mistakes to avoid enrollment checklist missed your enrollment period?

After Enrollment

You’re enrolled, congrats! Don’t miss your enrollment packet in the mail.

enrollment packet

Additional Learning Guides

Previous Next

Before 65 Guide

Understanding health insurance before age 65, especially when considering early retirement.

Medicare Plans Guide

Costs, coverage and enrollment details for each Medicare plan.

Medicare Beneficiary Guide

For those currently enrolled in Medicare.

Low Income & Medicare Guide

For individuals with a qualifying income status.

A Caregiver’s Guide

For those helping a loved one with Medicare.

Discover how GoHealth can help you.

Speak with our licensed insurance agents, anytime.

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.