Medicare Basics

What is Medicare?

Medicare is the federal health insurance program for people 65 or older, people under 65 with certain disabilities, and people of any age with End-Stage Renal Disease (ESRD).

When and how do I sign up for Medicare?

If you're already getting Social Security benefits, you'll be automatically enrolled into Medicare and will receive your Medicare card three months before your 65th birthday (or 25th month of disability).

If you're not receiving Social Security then you may need to manually sign up for Medicare Part A & Part B during your Initial Enrollment Period one of the following ways:

What are the different parts of Medicare?

partA

Part A helps pay for hospital, skilled nursing facility, home care, and hospice. In most cases, if you paid into Medicare while working you will not have to pay for Part A.

partB

Part B helps pay for physician services, outpatient care, durable medical equipment, and other medical services. Most people will pay a monthly premium for Part B.

Part A & Part B is known as Original Medicare and covers about 80% of allowable medical charges.

partC

Part C refers to Medicare Advantage plans. You must have Part A and Part B to qualify. Medicare pays a private insurer to provide your healthcare coverage. This incorporates your Part A, Part B, and usually Part D into one plan. These plans start at $0.00 per month and may include extra benefits not covered by Original Medicare.

partD

Part D refers to prescription drug coverage. People with Original Medicare & Medicare Supplement coverage must purchase a Part D plan separately. Part D is usually included for those on Medicare Advantage (Part C) plans.

What are Medicare Supplement (Medigap) plans?

Medicare Supplement (also known as Medigap) plans fill the gaps of Original Medicare, which is usually the 20% of allowable medical charges that Original Medicare doesn't cover.

  • Insurance companies offering Medicare Supplements must use standardized benefit packages.
  • Medicare Supplements do not include Part D prescription drug coverage.
  • Medicare Supplements do not include benefits beyond what Medicare covers; such as dental, vision, and hearing coverage.
  • Medicare Supplements may require applicants to pass a health questionnaire to qualify for coverage.
  • Most Medicare Supplement plans allow you to receive care from any Medicare-certified provider who accepts Original Medicare.

What are Medicare Advantage plans?

Medicare Advantage plans provide all of your Part A, Part B, and usually Part D benefits. These plans are offered by private insurance companies that are paid by Medicare to assume responsibility for your healthcare.

  • Insurance companies market a variety of benefit designs that are closely monitored and approved by Medicare.
  • Medicare Advantage plans usually include preset copays, coinsurance, and out-of-pocket limits for medical services.
  • Medicare Advantage plans may include benefits beyond what Medicare covers; such as dental, vision, hearing aids, and international emergency coverage.
  • Medicare Advantage plans do not require medical underwriting, except that the applicant must not have End Stage Renal Disease.
  • Most healthcare providers only accept certain Medicare Advantage plans, which use various types of networks (HMO, PPO, etc.).

Medicare Supplement vs. Medicare Advantage

What are my coverage choices?

 
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