The Ultimate Guide to Medicare
If you’re turning 65, it’s time to start exploring the many options of Medicare! We get it – healthcare can be overwhelming. Our Insurance Services Team is here to help guide you through the process and answer any questions you might have. We have included a brief guide to help you understand the different parts and steps associated with Medicare enrollment below.
What is Medicare Part A?
Medicare Part A, also known as Original Medicare, is defined as hospital insurance. This means it covers the costs billed by hospitals or other similar inpatient settings. You’ll need to enroll in Medicare Part A during your Initial Enrollment Period. If you are aging into the Medicare program, this runs from three months before your 65th birthday through three months after. If you miss your Initial Enrollment Period, you’ll be charged a penalty fee when you eventually enroll.
Medicare Part A coverage includes:
- Hospital Care
- Skilled Nursing Facility Care
- Nursing Home Care
- Home Health Services
What is Medicare Part B?
Medicare Part B is also known as Original Medicare and complements Medicare Part A. It covers outpatient services, preventative care, and durable medical devices. Some people will be automatically enrolled in Part B, while others will have to enroll on their own. If you receive Social Security benefits or Railroad Retirement benefits, your Part B premium will be automatically deducted from your monthly benefit checks.
Medicare Part B coverage includes:
- Outpatient Services (Doctor Visits)
- Preventative Services
- Annual Wellness Visit
- Ambulance Transportation
- Durable Medical Devices
What is Medicare Part C?
Medicare Part C is more commonly known as “Medicare Advantage” because it is separate from Original Medicare parts “A” and “B.” Medicare Advantage plans are offered by private insurance carriers and can include more benefits than what the government Medicare program includes. Some people may even be able to get $0 premium Medicare Advantage plans.
Medicare Part C coverage includes:
- Medicare Fitness Programs
- Non-Emergency Medical Transportation
- Dental & Vision
- Sometimes Prescription Drug Coverage
What is Medicare Part D?
Medicare Part D provides prescription drug coverage to Medicare beneficiaries. Original Medicare (Part A and Part B) by itself does not provide any prescription drug coverage. You can get prescription coverage by either enrolling in a separate Part D plan or Medicare Advantage (Part C). Every Part D plan will have its own list of covered drugs and is divided into tiers based on drug costs. Generally, generic drugs are cheaper than brand-name drugs. Like any other plan, you’ll have a Part D premium, deductible, and copayments.
Medicare Part D coverage includes:
- Prescription Drug Coverage
- Multiple Tier Costs
What Are Medicare Supplement Plans
Medicare Supplement plans help you pay for your copayments, coinsurance, and deductibles. They are often called “Medigap” because they help you fill the gap between what your health insurance covers and what you need to pay for. Some Medigap plans include prescription drug coverage and other benefits, but most are simply designed to help you cover those pesky “extra” costs.
Medicare Supplement plans include:
- Help with Copayments, Coinsurance, and Deductibles
- Prescription Drug Coverage
- Coverage for Extra Costs
Medicare Enrollment Calendar
Did you know that each year you only have a small window to make changes to your Medicare plan? That’s why it’s so important to review your plan each year and decide if you want to make changes. Everyone is allowed to make changes in the Medicare program during the Annual Enrollment Period (AEP), from October 15 through December 7.
For a list of all other dates refer to the calendar below.
Steps to Medicare Enrollment
Step 1: Basic Research
- Learn the basics of Original Medicare, Medicare Advantage, Medicare Supplement, and Part D
- Contact your doctors to see if they accept Medicare
- Learn how your current coverage works with Medicare
Step 2: Organize Health Information
- Create a list of all prescriptions including dosages and current costs
- Have your Social Security number
- Other Insurance plans and policy numbers
- Have health providers names, phone numbers, and addresses
Step 3: Meet with Licensed Agent
- Schedule an appointment with a licensed agent to discuss Original Medicare, Medicare Advantage, Medicare Supplement, and Part D
- Calculate monthly and yearly costs of premiums, deductibles, copays, and coinsurance
I'm Turning 65 and...
If you receive Social Security, you’ll be automatically enrolled in Part A and B. If you do not receive Social Security, you need to enroll in Part A and B yourself. It is important that you enroll during your Initial Enrollment Period (IEP) to avoid any late-enrollment penalties.
I have Railroad Retirement Benefits.
If you are currently receiving benefits, you will be automatically enrolled in Part A and B. If you have collected benefits in the past, but are no longer receiving benefits, contact RRB to enroll in Medicare.
I’m covered through my spouse.
Have your spouse contact their HR to determine if coverage will continue. If coverage continues, you can defer enrollment in Part A and B.
I’m still working.
You should still enroll in Part A because it’s premium-free if you have worked and paid Medicare taxes for 10 years. If your employer has more than 20 employees, you can defer enrollment. If your employer has less than 20 employees, you still need to enroll in Part B to avoid a late-enrollment penalty. Also, confirm that your employer’s prescription coverage meets Medicare’s credibility requirements. If it does not, you can purchase a Part D plan.
I am a veteran.
If you have VA coverage when you turn 65, you are not required to enroll in Part A or B. However, you may still want to for additional coverage.
I have COBRA.
COBRA coverage generally ends when you enroll in Medicare. Enroll in Part A and B during your Initial Enrollment Period to avoid a late-enrollment fee.