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.
There’s a lot to learn about Medicare, so let’s start with the basics.
Know your enrollment dates. If you are late, it could cost you.
Watch for your enrollment packet in the mail.
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.
Learn more about the parts of Medicare, and Medicaid.
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.
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:
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.
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:
Pro Tip: If you delay enrollment when first eligible, you may be responsible for a lifetime late enrollment penalty once you enroll later.
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.
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.
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
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
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You’re enrolled, congrats! Don’t miss your enrollment packet in the mail.enrollment packet
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If you’re looking for the government’s Medicare site, please navigate to www.medicare.gov.