MEDICARE 101

What is Medicare

Medicare is individual health insurance offered through the federal government for US Citizens and other eligible people 65 or older or those with a qualifying disability, ESRD or ALS. It is broken into four Parts and is discussed below.

Starting Medicare at 65

Turning 65 initiates your initial enrollment period (IEP) with Medicare. This time period allows you 7 months to enroll in Medicare- 3 months before your birth month, the month of and three months after. Part A is typically premium free. Part B has a premium and is set by Medicare.

Who starts Medicare at 65?

If you have retired from employment and do not have insurance through a spouse’s employment or work past 65 for a company with fewer than 20 employees, you will most likely want to enroll in Medicare during your initial enrollment period when turning 65. Coverage may be delayed if you continue to work past 65 and have employee benefits or have coverage through a spouse’s employment. There will be a special enrollment period in this circumstance that will allow you to begin Medicare without penalties.

If you have started Social Security benefits at least 4 months prior to turning 65, you will be automatically enrolled in Medicare. Approximately 3 months prior to your 65th birth month, Medicare will mail you your identification card.

If you have not enrolled in Social Security benefits you will need to complete an application by visiting SSA.gov, calling Social Security to set up a telephone appointment or to make an in person appointment. It is strongly suggested that you start this process the third month prior to your birth month to avoid delays.

Need help deciding whether to enroll in Medicare at 65? Click Here

The Parts of Medicare

Medicare is divided into four parts. Part A and Part B are often referred to as Original Medicare.

Part A -Hospital insurance: Covers hospital care, emergency services, skilled nursing care, home health services and hospice.

Part B -Medical insurance: Covers preventive care and medically necessary services and supplies used for diagnosing and treating medical conditions, Covered services include doctor office visits, durable medical equipment, diagnostic services and outpatient services.

Part C - Medicare Advantage: Managed Care option provided by private companies in lieu of Original Medicare. These plans must offer the equivalent of Part A and B of Medicare and often have Prescription Drug coverage. They may include additional coverage not provided by Part A or Part B, such as dental and vision. Common plan options are HMO and PPO Networks.

Part D: Provide prescription drug coverage.

Additional Coverage Options

Medicare Supplements: These plans are offered by private companies to help with the the approximate 20% of costs that Part A and Part B leave the beneficiary responsible for. There are 10 supplement plans to choose from and each varies in coverage level and premium. These can only be used with Original Medicare (Parts A and B).

Dental and/or Vision: Original Medicare does not cover routine dental or vision so many will purchase a stand alone plan to help with theses services.

Hospital Indemnity: Hospital indemnity insurance is an insurance plan you can purchase in addition to your health insurance plan. They have a monthly premium and based on the coverage amounts you select, you receive a fixed benefit amount paid directly to you to help cover expenses for hospital stays, emergency room visits, skilled nursing, etc.

Find more in-depth information at MEDICARE.GOV