What is Medicare?

Medicare is a federal health insurance program primarily for people aged 65 or older, although it also covers younger individuals with certain disabilities and diseases.

Who is eligible for Medicare?

Generally, Medicare is available for people who are 65 or older, younger people with disabilities, and people with End Stage Renal Disease (permanent kidney failure requiring dialysis or transplant). Medicare is also available to individuals who have been on disability for 24 months.

What are the different parts of Medicare?

Medicare Part A (Hospital Insurance): Covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

Medicare Part B (Medical Insurance): Covers certain doctors’ services, outpatient care, medical supplies, and preventive services.

Medicare Part C (Medicare Advantage Plans): A type of Medicare health plan offered by a private company that contracts with Medicare to provide all your Part A and Part B benefits.

Medicare Part D (prescription drug coverage): Adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans.

How do I enroll in Medicare?

You can enroll in Medicare through the Social Security Administration (SSA) either online, by phone, or in person at a local Social Security office.

When can I enroll in Medicare?

There are specific enrollment periods for Medicare. The Initial Enrollment Period (IEP) starts three months before you turn 65 and ends three months after the month you turn 65. There are also Special Enrollment Periods (SEPs) for those who qualify, and the General Enrollment Period (GEP) from January 1 to March 31 each year.

Do I automatically get enrolled in Medicare when I turn 65?

If you are receiving Social Security benefits, you will automatically be enrolled in Medicare Part A and Part B starting the first day of the month you turn 65. If you are not receiving Social Security benefits, you will need to sign up for Medicare.

What does Medicare Part A cost?

Most people don’t pay a premium for Part A if they or their spouse paid Medicare taxes while working at least 40 quarters. For those who have to buy Part A, the cost can be up to several hundred dollars a month.

What does Medicare Part B cost?

The standard Part B premium amount is typically adjusted annually, and you may pay more if your income is above a certain amount.

What is a Medicare Advantage Plan?

Medicare Advantage Plans are an “all in one” alternative to Original Medicare. These plans are offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, you still have Medicare, but you’ll get your Medicare Part A and Part B coverage from the Medicare Advantage Plan and not Original Medicare.

Do I need a Medicare Supplement Insurance (Medigap) policy?

If you have Original Medicare, you might want to buy a Medigap policy to cover gaps like copayments, coinsurance, and deductibles. Medigap policies are sold by private companies and come with an additional monthly premium to what you will pay for Medicare Part B.

How does Medicare work with other insurance?

Medicare coordinates benefits with most other types of insurance. If you have other health insurance, Medicare will determine whether it is the primary or secondary payer depending on the situation.

Can I have both Medicare and Medicaid?

Yes, individuals who qualify can be “dual eligible” for both Medicare and Medicaid, and most health care costs are typically covered between the two programs.

What is the late enrollment penalty for Medicare Part B?

If you do not sign up for Medicare Part B when you are first eligible, you might have to pay a late enrollment penalty for as long as you have Part B. The penalty could be 10% for each full 12-month period that you could have had Part B but didn’t sign up for it. If you continue working past your 65th birthday and have creditable group health coverage you will not be subject to this penalty.

Can I switch from Original Medicare to a Medicare Advantage Plan?

Yes, you can switch during the Annual Election Period (AEP), also known as the Open Enrollment Period for Medicare Advantage and Medicare prescription drug coverage, which runs from October 15 to December 7 each year. During this period, you can switch from Original Medicare to a Medicare Advantage Plan.

How do I choose between different Medicare plans?

Choosing between different Medicare plans involves comparing the benefits, costs, network of providers, coverage options, and drug formularies (list of covered drugs) of each plan. You may also consider factors like additional benefits offered by Medicare Advantage plans, such as dental, vision, and wellness programs.

What are Special Needs Plans (SNPs) in Medicare?

Special Needs Plans (SNPs) are a type of Medicare Advantage Plan that provide specialized health care for specific groups of people, such as those who have both Medicare and Medicaid, live in a nursing home, or have certain chronic medical conditions. SNPs tailor their benefits, provider choices, and drug formularies to meet the specific needs of the groups they serve.