Medicare Made Simple
If you are new to Medicare or find navigating the Medicare process confusing you are not alone. With so many parts and plans, it can be overwhelming.
What is Medicare?
Medicare is federal health insurance available for eligible individuals age 65 and over. There are also circumstances where Medicare is available to individuals under 65 with certain disabilities or medical conditions. Medicare currently consists of four different coverage parts labeled A, B, C, and D. All coverage parts have specific enrollment time frames depending on the plan you choose. Let’s start with reviewing each of the Medicare parts and add-on options outlined below.
What Are Original Medicare Parts & What Do They Cover?
Original Medicare is a government insurance program. In most cases, it is for individuals aged 65 and older. This has two parts:
MEDICARE PART A
Medicare Part A (or hospital insurance) generally helps cover hospital stays, care in a skilled nursing facility, hospice care, and some home health care services. With Medicare Part A, you typically pay a deductible and coinsurance and/or copayments.
MEDICARE PART B
Medicare Part B (or medical insurance) covers health services from your doctor. This includes outpatient medical care, medical care, and preventative care like vaccines. Under Medicare Part B, in most cases, you will pay 20% of the Medicare-approved amount for certain items and services. A deductible may also apply with Part B.
When & How to Enroll in Original Medicare (Parts A & B)
INITIAL ENROLLMENT PERIOD
This is the best time to enroll in Original Medicare and any other supplementary plans. For example, if your 65th birthday is May 6th, you can start enrolling in Original Medicare between February and August.
SPECIAL ENROLLMENT PERIOD
Gives you the opportunity to enroll in Original Medicare after your initial enrollment period or after age 65 with no penalty. Typical qualifications include, but are not limited to:
- Newly Retired
- Change in Medicaid or Extra Help
- Loss of Group Coverage
What Additional Medicare Coverage Options Are Available?
MEDICARE PART C
If you are looking for another way to get Medicare coverage, Part C—or Medicare Advantage Plans—may be a lower out-of-pocket cost option to consider. With a Medicare Advantage plan, you will receive coverage for all Part A & B covered services. Most Medicare Advantage plans also include Part D drug coverage. Click here to learn more.
MEDICARE ADVANTAGE OPTION
Part A and Part B + Most plans include: Part D + Some plans also include: lower out-of-pocket costs and/or extra benefits
MEDICARE PART D
Part D prescription drug plans (also called PDPs) help people with Medicare to more easily afford prescription drugs. This coverage can help reduce your costs for medications and is available only from private companies. This is a separate drug plan that you purchase in addition to Original Medicare. Click here to learn more.
Here are the combinations of coverage you can have with a PDP:
- Original Medicare + PDP
- Original Medicare + PDP + Medicare Supplement Plan
- Medicare Advantage with Part D included
Since Medicare wasn’t designed to cover all health care expenses, you can purchase a Medicare Supplement plan (also known as a Medigap policy), in addition to Original Medicare. When you have a Medicare Supplement insurance policy, it helps fill the gaps that Original Medicare doesn’t. Different policies are identified by letters in the alphabet. Each policy has a different level of gap coverage. Click here to learn more about Medicare supplement plans.
MEDICARE SUPPLEMENT OPTION
Part A and Part B + You can add: Part D + You can also add: Supplemental coverage